Clinical Quality RN, Hedis

UnitedHealth Group • Eden Prairie, MN

226d • $23 - $46 • Remote

About The Position

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.

Requirements

• 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

Nice To Haves

• 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

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

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Insurance Carriers and Related Activities
• Education Level: Associate degree