Senior RN Call Center Remote

Careers at UnitedHealth Group

We're creating opportunities in every corner of the health care marketplace to improve lives while we're building careers. At UnitedHealth Group, we support you with the latest tools, advanced training and the combined strength of high caliber co-workers who share your passion, your energy and your commitment to quality. Join us and start doing your life's best work. SM


Compassion. It's the starting point for health care providers like you and it's what drives us every day as we put our exceptional skills together with a real feeling of caring for others. This is a place where your impact goes beyond providing care one patient at a time. Because here, every day, you're also providing leadership and contributing in ways that can affect millions for years to come. Ready for a new path? Learn more, and start doing your life's best work. SM

Our teams are helping people from around the world. We can bring out your best as you put your listening, analytical and problem solving skills to work in a setting that is geared to helping improve lives and enhance health care for millions. Here, you'll discover a wealth of pathways for professional growth within Customer Service, Billing, Claims, Enrollment & Eligibility and across our global economy. Join us and find out why this is the place to do your life's best work. SM

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm)

The Supervisor of the Clinical Quality Call Center Department supervises and coordinates staff and activities to ensure the delivery of quality HEDIS initiatives. This position ensures staff complies with all regulatory initiatives and policies and procedures and works with Management to support effective clinical operations. The Supervisor of the Clinical Quality Department will also provide support to clinic staff in the absence of the Department Manager.

Ess e n t ial Job F un ct ions

  • De v e lop m ar k e t busin e ss pl a ns to motiv a te p r ovid er s and large or complex group leadership to e n g a ge in imp r oving St ar s m e a su re s to be 4 STARS or higher
  • Place outbound calls to members to ascertain information from the patient regarding HEDIS and Quality measures related to their care as well as obtain member information regarding any possible gaps in care.
  • P r ovide a n a l y t i ca l int er p r e t a tion of St ar s a nd HE D I S r e po r ti n g , in c luding e x ec utive summ ar i e s to pl a n a nd p r ovid e r g r oups
  • B e the p r im a r y subject matter expert f or a ll S TA RS re l a t e d ac tiviti e s w ithin th e ir a ssi g n e d m a r k e t ( s) w o r king w ithin a m a t r ix re l a tionship w hi c h in c lu d e s Q u a li t y c o r po r a te op er a tions a nd R e g ion a l/M ar k e t op e r a tions.
  • L e a d or p ar ti c ip a te a nd p re s e nt in w e e k l y , Month l y , B i - month l y , Q u ar t e r l y a nd/or A nnu a l busin e ss R e vi e w m ee ti n gs re l a t e d to S TA R ac tiviti e s w hi c h summ ar i z e p r o vid e r and large g r oup p erf o r m a n c e a nd m ar k e t p erf o r m a n c e a s re q u e st e d b y or re qui r e d b y Q u a lity or R e g io n a l l ea d er ship.
  • A n a l y z e a nd e v a l u a te p r o vid e r and large g r oup st r u c tu r e a nd c h ar a c t er isti c s, p r ovid e r g r oup/p r ovi d e r o ff i c e o p era tions a nd p e r sonn e l to id e nti f y the m o st effec tive a pp r o ac h e s a nd st ra t e g i es
  • Assist in developing of training and analytical materials for Stars and HEDIS
  • I d e nti f y a nd a s s e ss d ec is i on m a k er s a nd oth e r k e y p r ovid e r g r oup p er sonn e l w ith a f o c us on id e nti f y i n g b a rr i er s to ac hi e ving t a r g e t e d out c om e s, focus communications and efforts accordingly
  • De v e lop solution - b a s e d, us e r fr i e nd l y initi a tiv e s to suppo r t p rac ti c e s u c c e ss
  • Performs all other related duties as assigned

  • 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:
    • Registered Nurse, licensed in the State of Texas, without restriction
    • 4+ years of healthcare experience in a managed care setting
    • 2+ years of experience in a Lead and/or Supervisory role
    • 2+ years of experience in HEDIS/Star programs, preferably in a clinical quality consultant role
    • 2+ years of experience in provider facing interactions, including provider education
    • 2+ years of experience with data analysis and/or quality chart reviews. Able to review data and provide recommendations for improvement
    • Solid knowledge of the Medicare market, products and competitors
    • Proven ability to influence providers to change behavior and drive improvement in quality performance
    • Experience in managed care working with network and provider relations
    • Demonstrated ability to interact with medical staff, peers, and internal company staff at all levels
    • Ability to solve process problems crossing multiple functional areas and business units
    • Solid problem-solving skills; the ability to analyze problems, draw relevant conclusions and devise and implement an appropriate plan of action
    • Experienced using Microsoft office applications, including databases, word-processing, and excel spreadsheets. Proficient in Excel
    • Excellent leadership and management skills
    • Knowledge of office management techniques and practices
    • Knowledge of human resource management techniques
    • Knowledge of organization policies and procedures and ability to apply principles to solve everyday problems in a variety of situations
    • Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance

    Preferred Qualifications:
    • Undergraduate degree, post graduate degree
    • Call Center Experience
    • Clinical data abstraction experience
    • Adaptable to change
    • Good business acumen, especially as it relates to Medicare
    • Ability to establish priorities and coordinate work activities
    • Solid written and verbal communication and presentation skills

    To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies now require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles require full COVID-19 vaccination as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

    Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors., WellMed is a network of doctors, specialists and other medical professionals that specialize in providing care for 550,000+ older adults with over 16,000 doctors' offices 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)

    WellMed was founded in 1990 with a vision of being a physician-led company that could change the face of healthcare delivery for seniors. Through the WellMed Care Model, we specialize in helping our patients stay healthy by providing the care they need from doctors who care about them. We partner with multiple Medicare Advantage health plans in Texas and Florida and look forward to continuing growth.

    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.

    Job Keywords: HEDIS, STARS, Clinical Quality RN, San Antonio, TX, Texas