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Hours Full-time, Part-time
Location Houston, TX
Houston, Texas

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)


 


Multiple positions that will be covering Harris county and surrounding areas: Target cities: Houston, Conroe, The Woodlands, Galveston, Pasadena, Channelview

 

This position will be a work at home and out in the field 75% of the time.

 

Primary Responsibilities:


  • This position is responsible for ongoing HEDIS collection and improvement activities at the health plan and reports to the Quality Management Leader

  • 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

  • Performs annual medical record evaluation, follow-up education, practitioner intervention, measurement (QI 13) as required

  • Enter documentation of findings in identified database

  • Generally works independently, under the supervision of the Quality Management leader

  • Participates in or coordinates with other department projects as needed

Requirements


United Healthcare Community & State is part of the family of companies that make United Health Group one of the leaders across most major segments of the US health care system.

If you're ready to help make health care work better for more people, you can make a historic impact on the future of health care at United Healthcare Community & State.

We contract with states and other government agencies to provide care for over two million individuals. Working with physicians and other care providers, we ensure that our members obtain the care they need with a coordinated approach.

This enables us to break down barriers, which makes health care easier for our customers to manage. That takes a lot of time. It takes a lot of good ideas. Most of all - it takes an entire team of talent. Individuals with the tenacity and the dedication to make things work better for millions of people all over our country.

You can be a part of this team. You can put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered.


 


Required Qualifications:




  • Active, unrestricted RN license

  • 5+ years clinical experience in any setting (acute care is preferred)

  • Ability to travel locally to assigned territory

  • Must be self-motivated and have ability to work autonomously

  • Ability to evaluate medical records with attention to detail

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

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

  • Proficiency in software applications that include, but are not limited to, Microsoft Word, Microsoft Excel, Microsoft Outlook, and Internet browsers

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

  • 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

 


Preferred Qualifications:




  • Previous quality improvement experience, or other related managed care experience (chart review, compliance, HEDIS, investigation, etc.)

  • Experience working in Medicaid and/or Medicare health care and insurance industry, including regulatory and compliance requirements

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

  • Bilingual – English/Spanish 

 


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, 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:  RN, Registered Nurse, HEDIS, Quality, Compliance, Medicaid, provider, clinical data collection, Spanish, Harris County, Houston, Katy, Spring, TX, Texas