UnitedHealth Group Sr. Clinical Compliance Nurse, WellMed - Dallas or Fort Worth, TX in Dallas, Texas

Talk about meaningful work. Talk about an important role. Let's talk about your next career move. Delivering quality care starts with ensuring our processes and documentation standards are being met and kept at the highest level possible. This means working behind the scenes ensuring a member-centric approach to care. As a Senior Clinical Compliance Nurse you will monitor and support health plan quality improvement initiatives with particular emphasis on compliance with state and federal regulatory and accreditation requirements. You'll act as a voice for our members, guiding the development of comprehensive care plans that will help others live healthier lives. Here's your opportunity to discover your life's best work.(sm)

We're focused on improving the health of our members, enhancing our operational effectiveness and reinforcing brand and reputation for high-quality health plans. Join us and help guide our efforts to improve the patient experience. It takes passion, commitment, intense focus and the ability to contribute effectively in a highly collaborative team environment.

Primary Responsibilities:

  • Design, create and implement Quality Improvement projects and initiatives

  • Extract appropriate metrics from SQL or Oracle environments

  • Conduct and manage outcomes of various studies that may include analyzing, reviewing, forecasting, trending, and presenting information for quality management planning and management needs

  • Provide analytical support and expertise when compiling and reporting information

  • Develop and present recommendations and alternatives for management and executive review

  • Assume responsibility for data integrity among various internal groups and/or between internal and external sources

  • Lead and/or mentor associates

  • Assist in developing department strategic action plans including identification of objectives, goals and strategies

  • Develop and implement effective analysis, research and evaluation of quality management metrics

  • Develop, analyze and monitor new, routine and ad hoc reports using multiple data sources and systems

  • Extract monthly MedMeasures summary reports and identify gaps

Required Qualifications:

  • Bachelor's Degree

  • Unrestricted Texas RN License

  • 5+ years of healthcare experience

  • 3+ years of compliance experience

  • 2+ years of experience developing and implementing performance improvement projects, or using data to develop intervention strategies to improve outcomes

  • Intermediate computer skills (Microsoft Word, Outlook and Internet) with the ability to navigate a Windows environment

Preferred Qualifications:

  • Experience creating reports related to quality improvement/performance outcomes

  • Experience with quality measures such as HEDIS, NCQA

  • CMS experience

  • Compliance audit experience

  • CCM experience

  • Demonstrated ability to manage multiple projects simultaneously

  • Ability to collect, analyze, and present data

Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 240,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)

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: compliance, risk adjustment, NCQA, rn registered, HEDIS, quality, CMS, dallas, tx, plano, fort worth, DFW, Fort Worth, Dallas, TX, Texas