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Clinical Quality Consultant - Stars

Job Description:

The Practice Performace Manager is responsible for program implementation and provider performance management which is tracked by designated provider metrics, inclusive minimally of 4 STAR gap closure and coding accuracy.  The person in this role is expected to work directly with care providers to build relationships, ensure effective education and reporting, proactively identify performance improvement opportunities through analysis and discussion with subject matter experts; and influence provider behavior to achieve needed results.

Multiple positions available.  You will cover one of the following markets: Memphis to Knoxville or Kingsport to Knoxville

Job Responsibilities:

  • Functioning independently, travel across assigned territory to meet with providers to discuss Optum tools and programs focused on improving the quality of care for Medicare Advantage Members.

  • Execute applicable provider group programs for health plan. 

  • Educate providers on how to improve their Risk Adjustment Factor (RAF) scores, which measure their patients' health status.

  • Establish positive, long-term, consultative relationships with physicians, medical groups, IPAs and hospitals.

  • Develop comprehensive, provider-specific plans to increase their RAF performance and improve their coding specificity.

  • Provide ongoing strategic recommendations, training and coaching to provider groups on program implementation and barrier resolution.

  • Act as lead to pull necessary internal resources together  in order to provide appropriate, effective provider education, coaching and consultation.  Training will include Stars measures (HEDIS/CAHPS/HOS/med adherence), and Optum  program administration, use of plan tools, reports and systems.

  • Coordinate and lead Stars-specific JOC meetings with provider groups with regular frequency to drive continual process improvement and achieve goals. 

  • Provide reporting to health plan leadership on progress of overall performance, HQPAFs, gap closure, and use of virtual administrative resource.  

  • Facilitate/lead monthly or quarterly meetings, as required by plan leader, including report and material preparation.

  • Provide suggestions and feedback to Optum and health plan.  

  • Work collaboratively with health plan market leads to make providers aware of Plan-sponsored initiatives designed to assist and empower members in closing gaps.

  • Includes up to 50 - 75% local travel.

Job Requirements:

  • Bachelor's degree required

  • A minimum of 1 year of Stars experience required

  • 5 years of healthcare industry experience required

  • Consulting experience highly preferred

  • Medical/clinical background preferred

  • Strong knowledge of the Medicare market

  • Strong communication and presentation skills

  • Strong relationship building skills with clinical and non-clinical personnel

  • Knowledge base of clinical standards of care, preventive health, and Stars measures

  • Strong problem-solving skills

  • Experience in managed care working with network and provider relations/contracting

  • Strong financial analytical background within Medicare Advantage plans (Risk Adjustment/STARS Calculation models)

  • Microsoft Office specialist with exceptional analytical and data representation expertise; Advanced Excel, Outlook, and PowerPoint skills required

OptumInsight is one of the largest and fastest growing health information companies. We specialize in improving the performance of the health system by providing analytics, technology and consulting services that enable better decisions and results. We integrate workflow solutions that deliver data in real-time, and create actionable insights - processing health information that relates directly to and affects one in four patients in the U.S, one in every three Medicaid dollars and one in every five emergency room visits. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance.

What can YOU do with the right information? At OptumInsight, the possibilities and the impact are limitless. No matter what your role is at OptumInsight, you'll be

empowered to ask more questions, develop better solutions and help make the health care system greater than ever. It's always fresh. It's always exciting. And it's

never been more important.

Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability status.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.

Key words: Stars, Performance Manager, Quality Advocate, Quality, Project Management, Consulting, Providers, Member Groups, Contracts, Health Plan, Quality Improvement, Field Based's Advice

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Job Category: Management
Health Care
Job Reference Code: UHG-551362-2
Position Type: Full-Time
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  • Clinical Quality Consultant - Stars @ UnitedHealth Group

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