There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Nursing here isn't for everybody. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Ready for a new path? Start doing your life's best work.(sm) Position 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 state specific quality measures. The Registered Nurse CPC will work closely with the quality director to coordinate an interdisciplinary approach to increased 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 Registered Nurse CPC 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 Quality Leadership of the Health Plan. Primary Responsibilities:Acts as strategic partner with participating practitioners and practice staff in assessing trends in quality measures and identifying opportunities for quality improvement Conducts targeted clinical education using approved materials related to HEDIS / State Specific quality measures for provider and staff during field visits. Serves as subject matter expert (SME) for assigned HEDIS / State Measures and preventive health topics Works 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 the Health Plan 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 and works with the team to identify strategies to overcome barriers and close clinical gaps in care Educates providers and office staff on proper clinical documentation, coding to close gaps in care, state-mandated quality metrics specifications, provider profiling, pay for performance measurement, and medical record review criteria Documents and refers providers' non-clinical / service issues to the appropriate internal parties Supports medical record collection and abstraction processes to drive optimal measurement and quality metric reporting during HEDIS data collection or for other focus studies as directed by the Plan Quality Director. Based on medical record audit findings, provides follow-up education, practitioner intervention, and measurement as needed to drive quality improvement Participates in or coordinates with other department projects as neededThis position is based in Warwick, Rhode Island, and will require travel to Physician offices in the area up to 75% of the time.
Required Qualifications:Bachelor's degree in Science or equivalent work experience 5+ years clinical experience, or other relevant experience 2+ years of quality improvement experience, or other relevant experience Knowledge of one or more of: clinical standards of care, preventive health standards, HEDIS, NCQA, governing and regulatory agency requirements, and the managed care industry Role requires travel to physician offices locally up to 75% of their time Ability to work independently and within an integrated team in a highly matrixed environmentPreferred Qualifications:Current unrestricted RN licensure in the state of operation Experience working in Medicaid and/or Medicare Highly preferred health care and insurance industry experience, including regulatory and compliance Master's degree Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.(sm) *All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy. Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Job Keywords: Quality, HEDIS, NCQA, Bachelor's degree, RN, Registered Nurse, quality improvement, clinical, master's degree, Medicare, Medicaid, Telecommute, Telecommuter, Telecommuting, Remote, Warwick, RI, Rhode Island
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.