Experienced Clinical Quality HEDIS Nurse - Remote - Part of Optum's Clinician-Led Care Organization

Join the Optum Family and Make a Difference in Healthcare

Optum, a leading health services company, is seeking an experienced Clinical Quality HEDIS Nurse to join our team remotely. As a part of our clinician-led care organization, you'll play a vital role in driving quality improvement initiatives and advancing the health of our community. With a focus on making healthcare better for everyone, Optum offers a collaborative and dynamic work environment that empowers you to live your best life at work and at home.

About Optum and WellMed

Optum is a global health services company that works to make healthcare more efficient, effective, and accessible. Our mission is to help people live healthier lives by providing innovative solutions and services that support healthcare professionals, patients, and families. WellMed, part of the Optum family, is a network of doctors, specialists, and other medical professionals dedicated to providing high-quality care to over 1 million older adults across Texas and Florida. With a focus on preventive healthcare, we're innovators in the field, striving to change the face of healthcare for seniors.

Job Summary

We're seeking a highly skilled Clinical Quality HEDIS Nurse to join our team. As a Clinical Quality HEDIS Nurse, you'll be responsible for driving consistency, efficient processes, and sharing best practices in a collaborative effort with the Quality team and leadership to facilitate a minimum 4-star rating. You'll participate in quality improvement initiatives, including Chart Chase and Supplemental Data Source (SDS) and Primary Source Verification (PSV), as well as Quality Assurance and Overreading work.

Key Responsibilities

• Complete SDS, PSV, Over-read throughout the year achieving and maintaining high productivity goals to improve Stars measures to be 4 STARS or higher
• Achieve and maintain a high level of accuracy rates of 98% or above
• Serve as a Subject Matter Expert on HEDIS Measures, DataRAP, and Chart Chase Tool (CCT)
• Be the primary go-to person for all STARS-related activities within assigned market(s), working within a matrix relationship that includes Quality corporate operations and Regional/Market operations
• Assist in developing training and materials to help the team achieve best practices in Stars and HEDIS
• Perform other tasks as requested or required by Quality
• Identify and assess decision-makers and other key provider group personnel, focusing on identifying barriers to achieving targeted outcomes
• Develop solution-based, user-friendly initiatives to support practice success

Requirements and Qualifications

Essential Qualifications:

• Bachelor of Science in Nursing, Healthcare Administration, or a related field (8+ years of comparable work experience beyond the required years of experience may be substituted in lieu of a bachelor's degree)
• Registered Nurse with current license in Texas or other participating compact States
• 5+ years of progressively responsible healthcare experience, including experience in a managed care setting, hospital settings, and/or physician practice setting
• 3+ years of experience in managed care with 2+ years of Utilization Management experience
• Knowledge and experience with CMS and/or NCQA
• Willing to occasionally travel in and/or out-of-town as deemed necessary

Preferred Qualifications:

• Health Plan or MSO quality, audit, or compliance experience
• Auditing, training, or leadership experience
• Solid knowledge of Medicare and HEDIS standards

Skills and Competencies

To succeed in this role, you'll need:

• Excellent communication and interpersonal skills
• Strong analytical and problem-solving skills
• Ability to work independently and collaboratively as part of a team
• Strong attention to detail and organizational skills
• Knowledge of HEDIS measures and quality improvement initiatives
• Experience with data analysis and reporting

Career Growth Opportunities and Learning Benefits

At Optum, we're committed to helping you grow and develop your career. We offer:

• Opportunities for professional growth and advancement
• Comprehensive training and development programs
• Access to cutting-edge technology and tools
• A collaborative and dynamic work environment

Work Environment and Company Culture

We offer a flexible and remote work environment that allows you to work from anywhere within the U.S. Our company culture is built on:

• Diversity, equity, and inclusion
• Collaboration and teamwork
• Innovation and creativity
• Recognition and rewards for outstanding performance

Compensation, Perks, and Benefits

We offer a comprehensive compensation package that includes:

• Competitive salary range: $58,800 to $105,000 annually
• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements)

Conclusion

If you're a motivated and experienced Clinical Quality HEDIS Nurse looking to make a difference in healthcare, we encourage you to apply for this exciting opportunity. Join our team and become part of a clinician-led care organization that's changing the way healthcare is delivered. Apply now and take the first step towards a rewarding career with Optum!