WellMed, part of the Optum family of businesses, is seeking a RN Manager to join our team. Optum is a clinician-led care organization that is changing the way clinicians work and live. 

As a member of the Optum Care Delivery team, you’ll be an integral part of our vision to make healthcare better for everyone. 

At Optum, you’ll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Here, you’ll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together.  

The WellMed Clinical Programs RN Manager is directly responsible to manage teams of clinical and nonclinical staff who perform central call initiatives such as performing telephonic outreach to retrieve and/or disseminate appropriate information as relates to member care and CMS quality measures as well as to resolve quality gaps.   Directly responsible for coordinating and implementing the HEDIS and STAR’s data collection and works collaboratively with VP of Clinical Operations and Quality STARS team to develop strategies for achieving a 5 STAR rating.   This role assists with data integrity and report preparation for all required data submissions.   

The Clinical Programs RN Manager provides direction and support to various corporate interdepartmental teams and WellMed markets in the implementation of strategies for closing care gaps.  This role reports initiatives to quality field teams across multiple markets. This role works closely and collaboratively with various functional areas of the healthcare and IT delivery systems to achieve the goals and objectives of the Quality Improvement Program. 

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. 

Primary Responsibilities:

Provides leadership and support in establishing and executing the Quality Performance Initiatives in alignment with corporate goals Manages and is accountable for professional staff, may oversee work activities of other supervisors, and coordinates the work activities of the team Adapts departmental plans and priorities to address business and operational needs/challenges in collaboration with senior leadership Monitors productivity, call center metrics, documentation and call quality to ensure established standards are met Influences or provides input to forecasting and planning activities Collaborates with physicians and support staff to execute the implementation of the clinical quality initiatives as defined by the enterprise Monitor progress toward plan goals through evaluation of the effectiveness of clinical programs and/or services provided Provides expertise to the corporate training department on STAR/HEDIS measures and on the tools that support the collection of STAR/HEDIS data Work with IT on the interpretation of technical specifications and impact of HEDIS/STAR Measures related to data collection applications and reports utilized for the support of HEDIS/STAR measures Participate in NCQA HEDIS or Health Plan audits Work with internal market teams and external vendors on data transmission issues Monitor and analyze large volume of electronic submissions for possible data deficit issues. Utilize internal audit tracking tools for review and validation of data integrity Analyze and trend HEDIS/STAR rates, identify barriers to improvement of rates based on HEDIS supplemental submission requirements via enterprise data systems and teamwork processes.  Provide process improvement strategies to enterprise leadership for improving data capture and outcomes Update QI Project templates, staff training materials, and Work Plans with assigned responsibilities Attend and participate in all QI related meetings Performs all other related duties as assigned

In 2011, WellMed partnered with Optum to provide care to patients across Texas and Florida. WellMed is a network of doctors, specialists and other medical professionals that specialize in providing care for more than 1 million older adults with over 16,000 doctors’ offices. At WellMed our focus is simple. We’re innovators in preventative health care, striving to change the face of health care for seniors. WellMed has more than 22,000+ primary care physicians, hospitalists, specialists, and advanced practice clinicians who excel in caring for 900,000+ older adults. Together, we're making health care work better for everyone. 

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:

Must hold active, unrestricted Registered Nurse eLNC Compact licensure in state of residency  5+ years of RN experience, including experience in a managed care setting 2+ years of experience in HEDIS/Star programs, preferably in a clinical quality consultant role. 2+ years of Call Center Experience 2+ years of experience with data analysis and/or quality chart reviews. Must be able to review paper and electronic medical records and charts Experienced using Microsoft office applications, including databases, word-processing, outlook, and excel spreadsheets. Must be proficient in Excel Solid knowledge of the Medicare HEDIS/Stars measures Demonstrated ability to interact with medical staff, peers, and internal company staff at all levels. Proven ability to manage multiple complex, concurrent projects Proven excellent written and verbal communication and relationship building skills Proven solid problem-solving skills; the ability to analyze problems, draw relevant conclusions and devise and implement an appropriate plan of action Proven excellent customer service skills and communication skills

Preferred Qualifications:

BSN degree or related field  CPHQ Certification  CHCQM Certification  3+ years of process management experience Healthcare Quality Improvement experience Proven excellent communication, writing, proofreading and grammar skills Proven effective organizational skills Proven solid attention to detail and accuracy, excellent Evaluative and Analytical skills Proven solid teamwork, interpersonal, verbal, written, and administrative and customer service skills Bilingual with preference given to Spanish

Physical & Mental Requirements:

Ability to lift up to 25 pounds Ability to sit 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 Ability to use fine motor skills to operate office equipment and/or machinery Ability to stand for extended periods of time

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy 

The salary range for this role is $89,800 to $176,700 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives. 

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. 

Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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. 

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.