**Experienced Clinical Quality HEDIS Nurse – Remote – Join the Optum Family and Revolutionize Healthcare**

About Optum and WellMed

Optum, a leading health services company, is seeking an experienced Clinical Quality HEDIS Nurse to join our team. As part of the Optum family of businesses, WellMed is a network of doctors, specialists, and other medical professionals dedicated to providing exceptional care to over 1 million older adults across Texas and Florida. With a focus on preventative healthcare, we’re innovators in the field, striving to change the face of healthcare for seniors.

As a Clinical Quality HEDIS Nurse, you’ll play a vital role in driving consistency, efficient processes, and best practices in a collaborative effort with the Quality team and leadership. Your expertise will help facilitate a minimum 4-star rating, and you’ll participate in quality improvement initiatives, including Chart Chase and Supplemental Data Source (SDS) and Primary Source Verification (PSV).

Job Summary

We’re looking for a highly skilled and experienced Clinical Quality HEDIS Nurse to join our team. As a remote employee, you’ll enjoy the flexibility to work from anywhere within the U.S. while taking on challenging responsibilities that drive quality improvement and patient outcomes. You’ll work alongside talented peers in a collaborative environment guided by diversity and inclusion, driving towards the Quadruple Aim.

Key Responsibilities
• Complete SDS, PSV, Over-read throughout the year, achieving and maintaining high productivity goals to improve Stars measures to 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 assigned market(s), working within a matrix relationship that includes Quality corporate operations and Regional/Market operations
• Assist in developing training and materials to help teams achieve best practices in Stars and HEDIS
• Perform tasks as requested or required by Quality
• Identify and assess decision-makers and other key provider group personnel, focusing on identifying barriers to achieving targeted outcomes
• Develop solution-based, user-friendly initiatives to support practice success

Essential Qualifications

Education and Experience
• Bachelor of Science in Nursing, Healthcare Administration, or a related field (8+ years of comparable work experience beyond the required years of experience may be substituted in lieu of a bachelor’s degree)
• Registered Nurse with current license in Texas or other participating compact States
• 5+ years of progressively responsible healthcare experience, including experience in a managed care setting, hospital settings, and/or physician practice setting
• 3+ years of experience in managed care with 2+ years of Utilization Management experience
• Knowledge and experience with CMS and/or NCQA

Skills and Competencies
• Strong knowledge of HEDIS measures and DataRAP
• Excellent communication and analytical skills
• Ability to work collaboratively in a matrix relationship
• Strong problem-solving and decision-making skills
• Willingness to occasionally travel in and/or out-of-town as deemed necessary

Preferred Qualifications
• Health Plan or MSO quality, audit, or compliance experience
• Auditing, training, or leadership experience
• Solid knowledge of Medicare and HEDIS standards

Work Environment and Culture

As a remote employee, you’ll enjoy the flexibility to work from anywhere within the U.S. Our company culture is guided by diversity and inclusion, and we’re committed to driving towards the Quadruple Aim. We believe in empowering our employees to live their best lives at work and at home.

Career Growth Opportunities and Learning Benefits

We’re committed to helping our employees grow and develop in their careers. You’ll have access to training and development opportunities, including leadership development programs, mentorship, and education assistance.

Compensation and Benefits

We offer a comprehensive benefits package, including:
• Competitive salary range: $58,800 to $105,000 annually
• Incentive and recognition programs
• Equity stock purchase and 401k contribution
• Comprehensive health insurance

Why Join Us?

By joining our team, you’ll be part of a talented and dedicated group of professionals who are passionate about making healthcare better for everyone. You’ll have the opportunity to work on challenging projects, develop your skills, and make a meaningful impact on patient outcomes.

If you’re a motivated and experienced Clinical Quality HEDIS Nurse looking for a new challenge, we encourage you to apply for this exciting opportunity.

Apply now and join our team!

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