HEDIS / Quality Nurse

$5,000 Sign On Bonus for External Candidates At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together As one of the largest pharmacy benefits managers in the United States, UnitedHealth Group provides a professional culture where you're empowered and encouraged to exceed the expectations of our members, with better schedules than retail and more reach than any hospital. Join us as we take on the challenge of reinventing the health system. The HEDIS / Quality Nurse will be responsible for strategically developing clinically oriented provider and community based partnerships in order to increase quality scores based on state specific quality measures. Position responsible for ongoing management of provider practice and community education on quality measures. The HEDIS / Quality Nurse will work closely with quality leadership to coordinate an interdisciplinary approach to increase provider performance. Provider education regarding the quality improvement program involves analysis and review of quality outcomes at the provider level, monitoring, measuring and reporting on key metrics to assist providers in meeting quality standards, state contractual requirements and pay for performance initiatives. The HEDIS / Quality Nurset will focus on tasks that occur in accordance with State, CMS or other requirements as applicable. Position responsible for direction and guidance on provider-focused, clinical quality improvement and management programs. The role assists contracted providers with analyzing member care, trending quality compliance at the provider level, and developing action plans and programs to support provider practices in continuous quality improvement using approved clinical practice guidelines, HEDIS, CMS, NCQA and other tools. Position reports to the BHO Quality Manager and BHO Quality Leadership. This is role requires up to 25% local travel to provider offices throughout Clark County. If you reside within a commutable distance from the Las Vegas, NV area, you will have the flexibility to work remotely* as you take on some tough challenges. Primary Responsibilities:

• Supports effective deployment of program at the practice level through strategic partnerships with participating practitioners and practice staff while assessing trends in quality measures and identifying opportunities for quality improvement
• Provides practice level quality transformation through targeted clinical education and approved materials related to HEDIS/State Specific quality measures for provider and staff education during field visits. Materials additionally include information from local, state, and national departments of health on key health related issues (understanding, exploring, educating and facilitating on a local level)
• Serves as subject matter expert (SME) for assigned HEDIS/State Measures, leads efforts with clinical and analytical teams to research and design educational materials for use in practitioner offices; serves as liaison with key vendors supporting HEDIS/State Measures; consults with vendors to design and implement initiatives to innovate and then improve HEDIS/State Measure rates
• Participates, coordinates, and/or represents BHO at community based organization events, clinic days, health department meetings, and other outreach events focused on quality improvement, member health education, and disparity programs as assigned
• Identifies population-based member barriers to care to identify local level strategies to overcome barriers and close clinical gaps in care
• Reports individual member quality of care concerns or trends of concern to the BHO Quality Manager
• Coordinates and performs onsite clinical evaluations through medical record audits to determine appropriate coding and documentation practices, compliance with quality metrics, compliance with service delivery and quality standards. May also be required to conduct additional QI audits through medical record review
• Based on medical record audit findings, provides follow-up education, practitioner intervention, and measurement as needed to drive quality improvement
• Educates providers and office staff on proper clinical documentation and coding practices, state-mandated quality metrics specifications and medical record review criteria
• Supports continuum of member care by identifying members in need of health education and/or services (interdisciplinary consultation) and refers Providers to the appropriate internal departments for follow through
• Documents and refers providers' non-clinical/service issues to the appropriate internal parties, to include but not limited to Provider Relations, etc.
• Works with Providers on standards of care, and advises Providers on established clinical practice guidelines, and appropriate documentation and coding consistent with state specific measures and technical specifications
• If required, supports state specific medical record collection and abstraction processes to drive optimum measurement and quality metric reporting during ambulatory medical record review, HEDIS data collection, or for other focus studies as directed by Quality Leadership
• Supports quality improvement program studies with work that ranges from accessing and analyzing Provider records, maintaining databases, and researching to identify members' encounter history
• Participates in or coordinates with other department projects as needed

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications:

• Current and unrestricted RN license in the state of Nevada
• 2+ years of Clinical Quality experience
• Experience educating Physicians, RNs or other clinical and/or non-clinical employees
• Electronic Medical Records (EMR) experience
• Proficient in Microsoft Excel, Word, and PowerPoint
• Ability to travel to physician offices locally up to 25% of the time

Preferred Qualifications:

• Behavioral health experience
• Managed care experience
• Previous HEDIS experience
• Acute care experience
• All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $72,800 to $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. #uhcpj Apply tot his job Apply To this Job