RN, Clinical Quality HEDIS Nurse - Remote

WellMed, part of the Optum family of businesses, is seeking a RN, Clinical Quality HEDIS Nurse to join our team in San Antonio, TX. 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 Clinical Quality RN will drive consistency, efficient processes and share best practices in a collaborative effort with the Quality team and leadership in order to facilitate a minimum 4 STAR rating. The Clinical Quality RN will participate in quality improvement initiatives including Chart Chase and Supplemental Data Source (SDS) and Primary Source Verification (PSV) as well as Quality Assurance and Overreading work. This position will work collaboratively with other staff members, managers and leadership and the market in a matrix relationship. You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Complete SDS, PSV, Over-read throughout the year achieving and maintaining high productivity goals in order to improve Stars measures to be 4 STARS or higher Achieve and maintain a high level of accuracy rates of 98% or above Serve as a Subject matter expert on HEDIS Measures, DataRAP and Chart Chase Tool (CCT) Be the primary go to person for all STARS related activities within their assigned market(s) working within a matrix relationship which includes Quality corporate operations and Regional/Market operations Assist in developing of training and materials to help team achieve best practices in Stars and HEDIS Performance as requested by or required by Quality Identify and assess decision makers and other key provider group personnel with a focus on identifying barriers to achieving targeted outcomes Focus communications and efforts accordingly Develop solution-based, user friendly initiatives to support practice success