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    est. per hour
    University of New Mexico - Hospitals 4h ago
    Just postedUrgently hiring2.9 mi Use left and right arrow keys to navigate
Use left and right arrow keys to navigate
Hours Full-time, Part-time
Location Albuquerque, NM
Albuquerque, New Mexico

About this job

There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Nursing here isn't for everybody. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Ready for a new path? Start doing your life's best work.(sm)



***This is a office position located at 8220 San Pedro NE Albuquerque, NM***


 


***Candidate must live in New Mexico and have the ability to travel 50-75% of the time. Will require overnight stay occasionally***


 


This position is responsible for ongoing HEDIS collection and improvement activities at the health plan and reports to the Clinical Quality Manager.


 


• Coordinates and performs onsite medical record reviews at provider offices to determine appropriate coding and billing practices, compliance with quality metrics, compliance with service delivery and quality standards, and where assigned investigation of quality of care and member complaints relative to quality of care and service.  Support continuum of member care by identifying members in need of health education, case management, etc.


• Educates providers and office staff on proper coding and billing practices, HEDIS and state-mandated quality metrics specifications, provider profiling and pay for performance measurement, and medical record review criteria.  Solicit identification of barriers the office faces in providing care to members. 


• Supports the HEDIS medical record chase to support optimum HEDIS and quality metric reporting.  


• Supports quality improvement program studies requesting records from providers, maintaining databases, and researching to identify members' provider encounter history


• Participates in and represents plan at community, health department, collaborative and other organizational meetings focusing on quality improvement, member education, and disparity programs, as assigned


• Identify member barriers to care and work with the QMP team to identify local level strategies to overcome


• Performs annual medical record evaluation, follow-up education, practitioner intervention, measurement (QI 13) as required by the New Mexico Health Plan


• Enter  documentation of findings in CPC database 


• Generally works independently, under the supervision of the Clinical Quality Manager


• Participates in or coordinates with other department projects as needed



 

Requirements

• RN/LPN with current licensure required


• 2+ years clinical experience or other relevant experience required

• Ability to travel to physician offices; valid state-specific driver's license and reliable vehicle requirement


• Ability to make formal presentations in front of committee and work group environments required.


• Ability to evaluate medical records with attention to detail required


• Ability to interact with medical staff, peers, and internal company staff at all levels required


• Ability to use databases and prepare reports as needed required


• Demonstrated ability to assist with focusing activities toward a strategic direction as well as develop tactical plans, drive performance and achieve targets required


 â€¢ Strong organizational skills and ability to work both independently and with teams required


• Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action required


• Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others required


 


Additional Assets:


 


 â€¢ Experience working in Medicaid and/or Medicare health care and insurance industry, including regulatory and compliance requirements preferred


• Knowledge base of clinical standards of care, preventive health standards, HEDIS, NCQA, governing and regulatory agency requirements, and the managed care industry preferred


  • Proficiency in software applications that include, but are not limited to, Microsoft Word, Microsoft Excel, Microsoft PowerPoint preferred


• Bilingual a preferred



Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 17 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: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability status.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.


 


Key Words: CPC, Clinical, RN, Registered Nurse, Nurse, LPN, Licensed Practical Nurse, medical records, HEDIS, NCQA, Albuquerque, New Mexico, NM