Senior Quality Nurse - Los Lunas New Mexico

Company: Optum
Location: Los Lunas, New Mexico
Posted On: 05/09/2025

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 to start Caring. Connecting. Growing together. -
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The Sr. Clinical Quality Consultant (CQC) RN will drive consistency, efficient processes and share best practices, in a collaborative effort with the provider and large or complex groups, designed to facilitate a minimum 4 STAR quality performance. -
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The Sr CQC will be provider facing and participate in quality improvement initiatives, attend monthly or joint operating committee meetings, and develop recommendations for quality improvement. This position is responsible for quality performance in their assigned region and will work collaboratively with the market team and their leadership in a matrix relationship. - -
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Primary Responsibilities: -

Develop business plans to motivate providers to improve STARS measure performance
Provide analytical interpretation and STARS/HEDIS performance summaries to provider groups
Be the subject matter expert for all STARS-related activities within their assigned territory working within a matrix relationship
Participate and present in weekly, Monthly, Bi-monthly, Quarterly and/or Annual business Review meetings related to STAR activities which summarize provider performance -
Analyze and evaluate provider structure and characteristics, including EMR utilization, office operations, and personnel to identify the most effective approaches and strategies to improve STARS measure performance
Assist in developing STARS/HEDIS presentation materials for provider performance meetings

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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 within NM and/or a compact state. -In lieu of RN license, Licensed Practice Nurse (LPN) with 5+ years of experience in HEDIS/STAR programs acceptable
4+ years of healthcare experience
2+ years of experience in provider-facing interactions
Experience and proficiency using Microsoft Office applications, including Outlook, Word, PowerPoint, and Excel spreadsheets
Ability to review clinical data and provide recommendations for improvement
Valid NM Driver's license and ability to travel 75% locally

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Preferred Qualifications: -


2+ years of experience in HEDIS/STARS, preferably in a clinical quality consultant role
2+ years of data analysis and/or quality chart review and abstraction
Billing and CPT coding experience
Medicare and/or Managed Care experience

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Physical & Mental Requirements: -


Ability to lift up to 10 pounds
Ability to push or pull heavy objects
Ability to sit for extended periods of time
Ability to stand for extended periods of time
Ability to use fine motor skills to operate office equipment and/or machinery Ability to properly drive and operate a vehicle
Ability to receive and comprehend instructions verbally and/or in writing Ability to use logical reasoning for simple and complex problem solving

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The salary range for this role is $71,600 to $140,600 annually 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.
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At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
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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. -
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OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. - More...

    

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