Supervisor of Quality Operations RN - 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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. The Supervisor of Quality Operations is responsible for management of the CEQ National Remote Data Mining and Provider Contact Center teams. This role leads a team of LPNs through year-round provider outreach for HEDIS® data collection. The supervisor will act as a systems, call center, and HEDIS® SME for their staff, assisting with call and technical specification questions. Through quality reviews, call monitoring, and quality and productivity reporting, the supervisor will ensure all data submitted to the health plan meets HEDIS®/STAR technical specifications for medical records and provide actionable feedback to their staff to promote continued success. This role assists the Manager of Quality Operations with communication of prioritization, strategy, and best practices. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.
Requirements
- Associate degree
- Registered Nurse
- 3+ years of HEDIS® experience
- 2+ years of experience acting as a team leader or SME
- Experience using Microsoft office applications, including databases, word-processing, Visio® and Excel® spreadsheets
- Proven excellent training and presentation skills with solid communication capabilities and practices, both oral and written
- Access to high-speed internet
Nice To Haves
- Bachelor’s Degree
- Certified Professional Coder
- 2+ years of call center experience
- 1+ years of supervisory or management experience
- Proven excellent training and presentation skills with solid communication capabilities and practices, both oral and written
- Proven ability to be flexible in a continuously changing environment
Responsibilities
- Serve as subject matter expert to clinical staff
- Coordinate and account for daily business activities
- Perform quality assurance on remote data mining
- Perform quality assurance on provider calls
- Perform quality assurance on the data entry and over read of non-standard supplemental data obtained from medical record review
- Navigate multiple documentation systems and obtain medical record sections supportive of HEDIS®/Star measures
- Review scanned records and data entry into supplemental data applications
- Support chart chase process by requesting records from provider’s offices as needed
- Maintain education/knowledge base of HEDIS®/STARs standards and guidelines
- Pull and review quality and productivity reporting
- Conduct training on HEDIS®/STAR measures, HEDIS®/STAR data collection software, and data collection strategies
- Assist with team coordination of system changes, and system upgrades
- Participate in debrief activities and continual process improvement exercises
- Perform all other related duties as assigned
Benefits
- In addition to your salary, we offer 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 us, you’ll find a far-reaching choice of benefits and incentives.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
