Clinical Quality RN, Hedis - Remote
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.
The Clinical Quality RN is a subject matter expert for Primary Source Verification and Supplemental Data Entry. They assist with the coordination of HEDIS® and STARs data gathering within Cozeva, DataRAP and other applications as needed. This role evaluates the quality and completeness of clinical documentation, by performing quality medical record reviews, assisting in the improvement of the clinical documentation process, maintaining accurate records of review activities, ensuring all data submitted to the health plan meets the HEDIS®/Star technical specifications for medical records. This role assists the Supervisor of Quality Operations with over reads and quality assurance checks.
You’ll enjoy the flexibility to work remotely* from anywhere within the U.S. (preferably in the CST or EST time zones) as you take on some tough challenges.
Primary Responsibilities:
- Review and abstract medical record data into appropriate application(s)
- Primary source verify abstracted medical record data
- Over read abstracted and verified medical record data
- Analyze chart data, evaluate for possible data integrity and/or data deficits and document findings
- Provide education and feedback to primary source verifiers and/or abstractors
- Support chart chase processes by requesting records from provider offices as needed
- Navigate multiple documentation systems and obtain medical record sections supportive of HEDIS/Star measures
- Support and improve communications between market and corporate departments
- Maintain education/knowledge base of HEDIS®/STARs standards and guidelines
- Assist with process improvement
- Performs all other related duties as assigned
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:
- Associate degree
- Registered Nurse
- 3 years of experience with data analysis/quality chart reviews. Must be able to review data and provide recommendations for improvement
- 2 years of HEDIS®/STAR experience
- Experience using Microsoft office applications, including databases, word-processing, and Excel® spreadsheets
- Proven excellent communication practices, both oral and written
Preferred Qualifications:
- Undergraduate degree
- Certified Professional Coder
- 1 years of process improvement experience
- Experience in training and excellent presentation skills
- Proven ability to be flexible in a continuously changing environment
Physical & Mental Requirements:
- Ability to lift up to 25 pounds
- Ability to sit for extended periods of time
- Ability to use fine motor skills to operate office equipment and/or machinery
- Ability to receive and comprehend instructions verbally and/or in writing
- Ability to use logical reasoning for simple and complex problem solving
*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
The hourly range for this role is $23.70 to $46.35 per hour 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.
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.
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.
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.
The Clinical Quality RN is a subject matter expert for Primary Source Verification and Supplemental Data Entry. They assist with the coordination of HEDIS® and STARs data gathering within Cozeva, DataRAP and other applications as needed. This role evaluates the quality and completeness of clinical documentation, by performing quality medical record reviews, assisting in the improvement of the clinical documentation process, maintaining accurate records of review activities, ensuring all data submitted to the health plan meets the HEDIS®/Star technical specifications for medical records. This role assists the Supervisor of Quality Operations with over reads and quality assurance checks.
You’ll enjoy the flexibility to work remotely* from anywhere within the U.S. (preferably in the CST or EST time zones) as you take on some tough challenges.
Primary Responsibilities:
- Review and abstract medical record data into appropriate application(s)
- Primary source verify abstracted medical record data
- Over read abstracted and verified medical record data
- Analyze chart data, evaluate for possible data integrity and/or data deficits and document findings
- Provide education and feedback to primary source verifiers and/or abstractors
- Support chart chase processes by requesting records from provider offices as needed
- Navigate multiple documentation systems and obtain medical record sections supportive of HEDIS/Star measures
- Support and improve communications between market and corporate departments
- Maintain education/knowledge base of HEDIS®/STARs standards and guidelines
- Assist with process improvement
- Performs all other related duties as assigned
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:
- Associate degree
- Registered Nurse
- 3 years of experience with data analysis/quality chart reviews. Must be able to review data and provide recommendations for improvement
- 2 years of HEDIS®/STAR experience
- Experience using Microsoft office applications, including databases, word-processing, and Excel® spreadsheets
- Proven excellent communication practices, both oral and written
Preferred Qualifications:
- Undergraduate degree
- Certified Professional Coder
- 1 years of process improvement experience
- Experience in training and excellent presentation skills
- Proven ability to be flexible in a continuously changing environment
Physical & Mental Requirements:
- Ability to lift up to 25 pounds
- Ability to sit for extended periods of time
- Ability to use fine motor skills to operate office equipment and/or machinery
- Ability to receive and comprehend instructions verbally and/or in writing
- Ability to use logical reasoning for simple and complex problem solving
*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
The hourly range for this role is $23.70 to $46.35 per hour 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.
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.
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.
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