There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Nursing here isn't for everybody. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Ready for a new path? Start doing This position is responsible for analysis and review of quality outcomes at the provider level, provider education on quality programs, monitoring and reporting on key measures to ensure providers meet quality standards and implementation of pay for performance initiatives . This position conducts audits which occur in accordance with State, CMS or quality related requirements. This role is responsible for the reporting and analysis of provider member care quality compliance *** Position is based out of the office at 6220 Old Dobbins Lane in Columbia, Maryland*** *** Candidates must be able to travel 75% of the time to providers offices to audits.*** Primary Responsibilities:Chart review in provider offices for coding validation to ensure documentation encompasses totality of member's conditions Education of provider and office staff regarding billing and encounter submission in accordance with health plan regulatory requirements Chart review in provider offices for compliance with applicable Quality/HEDIS/NCQA/State initiatives Education of provider and office staff on HEDIS/NCQA/State specifications and how to meet those requirements Support of plan and regulatory-required quality initiatives Hybrid Medical Record retrieval as necessary Document the presence of information that conforms to accepted standards of medical practice, which includes evidence of continuity and coordination of care Evaluate compliance with medical record HEDIS, NCQA, and State requirements
Required Qualifications:Current and unrestricted Registered Nurse License in the state of Maryland Working knowledge of Healthy Kids Program in Maryland 1-2 years' experience working in a Pediatrics or Family Practice Must be able to travel 75% of the time to Providers offices Intermediate Excel skills; Must be able to manipulate and sort data; maintain master files of practiceAssets:Must be comfortable providing presentations as a subject matter expert to provider and their office staff as well as at Provider Town Hall Meeting, Local Health Department Meetings Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.(sm) 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: RN, Nurse,registered nurse, Healthy Kids Program, Peds, Pediatrics, Family Practice, Providers, field, travel, CPC, HEDIS, NCQA, audit, quality, analysis, compliance, data, data mining, strategic, Excel, Columbia, Maryland, MD
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.