RN Senior Clinical Quality Consultant Compact Lics CST

Well Med, part of the Optum family of businesses, is seeking a RN Senior Clinical Quality Consultant to join our team anywhere within the U.S. 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. We believe you deserve an exceptional career, and will empower you to live your best life at work and erience 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 Well Med Quality Clinical Programs team supports Well Med Medical Management by delivering patient‑centered, clinically collaborative telephonic outreach to help people live healthier lives. Our team focuses on the design, execution, and delivery of telephonic and digital engagement strategies designed to close STARs measure gaps in care, e.g. medication adherence, care for older adults, medication reconciliation post discharge, A1c, etc.

Our interdisciplinary service delivery team is comprised of Registered Nurses, Licensed Vocational Nurses, and Social Workers.

The Registered Nurse will report into the Manager of Clinical Programs. The Registered Nurse will perform telephonic, patient‑centered clinical consults focused on Care for Older Adults annual pain and functional assessments. In addition, the RN will outreach telephonically for Transition of Care following hospital discharge to complete reviews as well as assist with appointment scheduling. The RN will be required to meet or exceed established productivity and quality metrics and work a flexible schedule to support the hours of operation of the business.

You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. Must have a compact license and willing to support CST.

• Strictly adheres to department's metrics and established advanced protocols and to handle incoming contacts including, but not limited to, prescription refill requests, lab results, x‑ray results, medical inquiries, patient education and referral requests
• Primarily to make outbound calls but occasionally help manage the inbound call queue from patients, patient representatives, providers and other medical staff, while strictly adhering to established protocols and scripting
• Review patient chart (in EMR) to ensure core measures are being addressed and met per protocol and takes appropriate action when they are not, i.e., schedule services
• Complete patient assessments for Transition of Care Medication Reconciliation Post Discharge, Care for Older Adults Pain and Function Assessments
• Educate patients on health conditions and necessity of route screening but assisting with appointment scheduling (A1c, Breast Cancer Screening, Colorectal Cancer Screening, Diabetic Eye Exam, etc.)
• Communicate with providers and offices to obtain needed evidence of completed lab work, screenings and care provided
• Review available medical records for core measures to submit for closure of HEDIS/STARS measures
• Assist patients with identification of and connectivity to community and program resources to assist with non‑medical needs, (Pharmacy assistance programs, meals on wheels, LIS)
• Document thoroughly all calls and actions taken within core systems
• Hours of Operations:
  Mon‑Fri 8am‑6pm Central and Required Rotating - Saturdays 8am‑5:30pm Central.
• Performs all other related duties as assigned

In 2011, Well Med partnered with Optum to provide care to patients across Texas and Florida. Well Med 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…