Clinical Quality LVN
Onsite
Hidalgo, TX, United States
Hidalgo, TX, United States
Posted 9 days ago
Job Details
Opportunities at WellMed, part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinical staff and non-patient-facing roles, you can make a difference with us as you discover the meaning behind Caring. Connecting. Growing together. WellMed provides concierge - level medical care and service for seniors, delivered by physicians and clinic staff that understand and care about the patient’s health. WellMed’s proactive approach focuses on prevention and the complete coordination of care for patients. WellMed is now part of the Optum division under the greater UnitedHealth Group umbrella. This position is responsible for the coordination of HEDIS and STARs data gathering process within the clinic setting. This role is responsible for the education to the clinic on quality measures and coordinates strategies for closing gaps. Evaluates the quality and completeness of clinical documentation processes by performing quality medical record reviews, assisting in the improvement of the clinical documentation process, maintaining accurate records of review activities, developing formal training and improvement programs and maintaining up-to-date knowledge of regulatory (HEDIS/STARs) standards and guidelines. Primary Responsibilities:
- Analyze data, evaluate for possible data integrity and data deficits and document findings
- Analyze and trend HEDIS/STAR rates, identify barriers to improvement of rates and create interpretive exhibits
- Obtains quality detail report and flags patient’s charts with the missing measures
- Works closely with local leadership to execute quality strategies
- Supports and assists PCPs/clinics with quality data collection
- Provides reports and monitors performance at local level
- Engages PCP and clinic staff in developing strategies to close quality gaps
- Supports and improves communications between market and corporate departments
- Maintains education/knowledge base of HEDIS/STARs standards and guidelines
- Performs all other related duties as assigned
- Licensed Vocational / Professional Nurse
- 3+ years of healthcare experience to include experience in a managed care setting
- 3+ years of experience with data analysis/quality chart reviews. Able to review data and provide recommendations for improvement
- Experience using Microsoft office applications, including databases, word-processing, and excel spreadsheets
- Must have reliable transportation, a valid driver's license, and auto insurance to travel within the local area
- Local Travel 50-75% required
- 2+ years of college, in pursuance of a Bachelor’s or Associate’s degree
- 2+ years of experience working with HEDIS / STAR measures
- HEDIS / STAR experience or participation with similar regulatory reporting
- Ability to lift up to 25 pounds
- Ability to sit for extended periods of time
- Ability to stand for extended periods of time
- Ability to use fine motor skills to operate office equipment and/or machinery
- Ability to receive and comprehend instructions verbally and/or in writing
- Ability to use logical reasoning for simple and complex problem solving
Learn more about UnitedHealth Group
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