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 and help people live healthier lives while doing your life's best work.(sm)This position is responsible for supporting the development and implementation of quality improvement interventions and audits along with the development, implementation, and regulatory response of the annual Healthcare Effectiveness Data and Information Sets (HEDIS) compliance audit. Primary Responsibilities:Assist in implementation and monitoring of quality studies including, but not limited to the development and implementation of preventive health and chronic disease outcomes improvement interventions such as newsletter article, member education and outreach interventions, provider education and outreach interventions, medical record review, focus studies and surveys Participate and contribute to external reviews and site visits preparations by the State, accreditation review, Medical Advisory Committee, and Quality Management Committee Coordinate with departments including, but not limited to Member Services, Provider Relations, Credentialing, Pharmacy and Claims to resolve provider and member issues related to quality of care issues In conjunction with the Quality Leader, analyzes and reports on the annual Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey Process, track and trend, and report quality of care issues for review by line of business for compliance May assist with medical file preparation for the Peer Review Committee and Fair Hearings/appeals and grievances Works with the PCMH and Provider Relations leaders to educate providers on quality documentation, including, but not limited to HEDIS data Completes special projects or assignments as needed to meet initiatives and/or objectives of the department
Required Qualifications: Current unrestricted RN licensure required in Virginia or ability to obtain prior to employment 5+ years clinical experience in any setting (with at least 1 year of acute care) 1+ year of quality improvement experience (chart review, compliance, HEDIS, investigation, etc.) Knowledge of one or more of: clinical standards of care, preventive health standards, HEDIS, NCQA, governing and regulatory agency requirements and the managed care industry Proficiency in software applications that include, but are not limited to, Microsoft Word, Microsoft Excel, Microsoft Outlook and Internet browsers Preferred Qualifications: Experience working in a managed care environment for Medicare and Medicaid Bachelor's Degree Bilingual 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: Registered Nurse, Nurse, RN, INTotal2017, Quality, Quality Improvement, Analyst, Health Care, Medicaid, Medicare, HEDIS, STARS, NCQA, Managed Care, Clinical Practice Consultant, Regulatory Compliance, CMS, Clinical, Project Manager, Falls Church, Virginia, VA, Telecommute, UHC, UnitedHealthcare, Community and State, Public Sector
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.