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Clinical Quality Consultant (STARS / HEDIS) - Greenville / Upstate, SC

UnitedHealth Group

Greenville, SC
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Job Details

744029 Clinical Quality Consultant STARS HEDIS Greenville Upstate SC

Clinical Quality Consultant (STARS / HEDIS) - Greenville / Upstate, SC (744029)

Position Description

Talk about meaningful work. Talk about an important role. Let's talk about your next career move. Delivering quality care starts with ensuring our processes and documentation standards are being met and kept at the highest level possible. This means working behind the scenes ensuring a member-centric approach to care. As a Clinical Quality Consultant, you will monitor and support health plan quality improvement initiatives with particular emphasis on compliance with state and federal regulatory and accreditation requirements. You'll act as a voice for our members, guiding the development of comprehensive care plans that will help others live healthier lives. Here’s your opportunity to discover your life's best work. (sm)


The Clinical Quality Consultant 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.


If you are located in Greenville or Upstate South Carolina, you will have the flexibility to telecommute* as you take on some tough challenges.


Primary Responsibilities:

  • Function 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 75% travel within a 2 hour radius

This is a field-based role with a home-based (telecommute, work at home) office. You will be spending approximately 75% of the time in the field within an assigned coverage area. Candidates must be willing to travel within the Greenville, Spartanburg and surrounding areas within a 2.5 hour radius

Required Qualifications:

  • Bachelor’s Degree
  • 3+ years of healthcare industry experience
  • Previous experience with STARS and HEDIS regulations and strong knowledge of Medicare
  • Strong financial analytical background within Medicare Advantage plans (Risk Adjustment / STARS Calculation models)
  • Knowledge base of clinical standards of care, preventive health, and Stars measures
  • Advanced MS Office Skills – specifically Excel – must have exceptional analytical and data representation expertise.
  • Advanced Outlook, and PowerPoint skills

Preferred Qualifications:

  • Medical / clinical background - LPN, RN, or PA licensure
  • Consulting experience or Project Management experience
  • Previous experience in a Sales focused role
  • Experience in managed care working with network and provider relations / contracting
  • Strong problem - solving skills
  • Must have highly effective communication and presentation skills
  • Superior relationship building skills with clinical and non-clinical personnel  

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world- s large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)


*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy


Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer 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.


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



Job Keywords: Clinical Quality Consultant, STARS, HEDIS, Greenville, Upstate, SC, South Carolina

Job Details

  • Contest Number744029
  • Job TitleClinical Quality Consultant (STARS / HEDIS) - Greenville / Upstate, SC
  • Job FamilyMedical and Clinical Operations
  • Business SegmentOptumInsight

Job Location Information

  • Greenville, SC
    United States
    North America

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelIndividual Contributor
  • ShiftDay Job
  • TravelYes, 75 % of the Time
  • Telecommuter PositionYes
  • Overtime StatusExempt

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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