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 Senior Quality Analyst 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) UHC HEDIS Operations is an integrated team serving all UnitedHealthcare businesses, focused on improving the health of our members, enhancing our operational effectiveness, reinforcing brand and reputation for high-quality health plans and helping members lives healthier lives. Our goal is extraordinary performance that exceeds the expectations of the constituents, customers and members we serve. In addition to supporting UnitedHealthcare as a whole, this position focuses on clinical quality improvement for our members. Generally work is self-directed and not prescribed. Individual will work with more complex issues and serve as a resource to others. Individual must be highly organized, possess strong leadership skills, with demonstrated professional maturity and emotional resilience. Exhibits creative problem solving skills, adapting approach as needed for each engagement. Primary Responsibilities:HEDIS Production Season Manage Temporary staff hired to support production, aka, hybrid chart chase Participate in interviewing and hiring Support onboarding and training Conduct additional trainings as needed based on staff needPull Vendor Pend List, and create work list for contractor Assign vendor pend list to Administrative contractors Review List from Administrative contractors Respond / work with the Administrative contractors on vendor pendsWork high complexity pends Conduct outreach with difficult Providers Childhood Immunization Look up Support Internal collection activities, i.e., Eye, Lab, Hepatitis B Limited Abstraction / Data Entry support Conduct over read of medical charts to assess member's compliance with HEDIS measure Pull medical records via remote electronic medical record retrieval systemVendor Oversight at the Project/Market level Attend Meetings Support pend resolution Run reports Manage special handlingOrphan / Unlinked member research and QA Review Identify opportunities for Rate Maximization to achieve optimal Hybrid rates HEDIS Non-Production Season Lead and / or participate in production debrief activity Post Production 'Lessons Learned' Create template and local report outMedical Record Requests and PNLS Special Handling Calls and PUSH Data Entry MRR - Medical Record Review- selected E&I plans participate for certain measures DRG Systems Testing / User Acceptance / Beta Testing Complete annual Technical Specifications training Support state required audits and state reporting Collaborate with the HEDIS Project Managers in the collection of RFI, ROADMAP and HOQ information for HEDIS Participate with Regional Quality Team to identify and implement region and or state-specific projects to improve HEDIS scores, CMS Star Ratings and other metrics Identify opportunities and actively participate in process improvements related to enhancing health plan quality Assist in developing targeted educational reminders for clinical/preventive initiatives Other responsibilities as assigned
Required Qualifications: Undergraduate degree or demonstrated equivalent experience Minimum of 4 years Healthcare / Health Plan experience Minimum of 2 years HEDIS experience and / or medical record review Solid knowledge of managed care requirements related to clinical quality Demonstrated ability to assist with focusing activities toward a strategic direction and achieve targets Adaptable to a highly changing environment; ability to quickly shift focus as priorities change Build trust and form effective relationships with stakeholders by providing timely operational updates, partnering on issue resolution/mitigation strategies Strong data management and / or project management skills Demonstrated ability to assist with focusing activities toward a strategic direction and achieve targets Excellent team development skills Excellent time management and prioritization skills Communicate effectively and persuasively, excellent interpersonal and communication skills, both written and verbal Strong proficiency with Microsoft Office applications, including: Word, Excel and PowerPoint Preferred Qualifications: Minimum of 1 year of experience working with HEDIS vendors, demonstrated ability specific to management, building relationships, issue resolution etc. Experience working with Providers / Provider Groups Knowledge of CMS STARs Experience coordinating work streams across multiple business partners, emphasis on collaboration and issue resolution Clinical and / or Health Education experience (RN or LPN desired) Proficiency with Microsoft Access Application of continuous quality improvement concepts, such as Six Sigma or PDSA Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can 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: Clinical Quality, HEDIS vendors, Quality Analyst, Telecommute, Telecommuting, Telecommuter, Remote, Work from Home
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.