Clinical Quality LVN Harlingen, TX

WellMed, part of the Optum family of businesses, is seeking a Licensed Vocational/Professional Nurse to join our team in Harlingen and Cameron, 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.

This position is responsible for the Primary Source Verification process and coordination of HEDIS and STARs data gathering process within the eCW and DataRaps applications. This role evaluates the quality and completeness of clinical documentation processes by performing quality medical record reviews, assisting in the improvement of the clinical documentation process, maintaining accurate records of review activities, ensures all data submitted to the health plan meets the HEDIS/Star technical specifications for medical records.

Primary Responsibilities:

• Analyze data, evaluate for possible data integrity and data deficits and document findings
• Over reads the data entry of non-standard supplemental data obtained from medical record review
• Navigate multiple documentation systems and obtain medical record sections supportive of HEDIS/Star measures
• Review of scanned records and data entry into DataRaps application
• Support chart chase process by requesting records from provider’s offices as needed
• Supports and improves communications between market and corporate departments
• Maintains education/knowledge base of HEDIS/STARs standards and guidelines
• Performs all other related duties as assigned

In 2011, WellMed partnered with Optum to provide care to patients across Texas and Florida. WellMed is a network of doctors, specialists and other medical professionals that specialize in providing care for more than 1 million older adults with over 16,000 doctors’ offices. At WellMed our focus is simple. We’re innovators in preventative health care, striving to change the face of health care for seniors. WellMed has more than 22,000+ primary care physicians, hospitalists, specialists, and advanced practice clinicians who excel in caring for 900,000+ older adults. Together, we’re making health care work better for everyone.

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:

• Licensed Vocational/Professional Nurse
• 3+ years of healthcare experience to include experience in a managed care setting
• 3+ years of experience with data analysis/quality chart reviews. Must be able to review data and provide recommendations for improvement
• HEDIS/STAR experience or participation with similar regulatory reporting
• Experienced using Microsoft office applications, including databases, word-processing, and excel spreadsheets
• TX Driver’s license and access to reliable transportation
• Ability to travel in Harlingen and Cameron, TX area

Preferred Qualifications:

• 2+ years of college, in pursuance of a Bachelor’s or Associate’s degree
• 2+ years of experience working with HEDIS/STAR measures

Physical & Mental Requirements: 

• Ability to lift up to 25 pounds
• Ability to stand for extended periods of time
• Ability to use fine motor skills to operate office equipment and/or machinery 
• Ability to receive and comprehend instructions verbally and/or in writing 
• Ability to use logical reasoning for simple and complex problem solving

The hourly range for this role is $19.86 to $38.85 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

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