HEDIS Clinical Quality Analyst - Telecommute - Full-time / Part-time

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm)
 
UHC HEDIS Operations is an integrated team serving all UnitedHealthcare businesses, focused on improving the health of our members, enhancing our operational effectiveness, reinforcing brand and reputation for high-quality health plans and helping members lives healthier lives. Our goal is extraordinary performance that exceeds the expectations of the constituents, customers and members we serve. In addition to supporting UnitedHealthcare as a whole, this position focuses on clinical quality improvement for our members. Individual will analyze and investigate issues and work with team members to implement resolutions as needed. Individual must be highly organized, possess strong leadership skills, with demonstrated professional maturity and emotional resilience. 
 
***This position can be located at any UnitedHealth Group location in the U.S.***
Primary Responsibilities:
 
HEDIS Production Season


Work medium complexity pends

Respond/work with the Administrative contractors on vendor pends
Conduct outreach to Providers
Childhood Immunization Look up
Support Internal collection activities, i.e., Eye, Lab, Hepatitis B
Support remote access look ups

Vendor support at the Project/Market level

Attend Meetings
Support pend resolution
Run reports
Manage special handling
Orphan/Unlinked member research and QA Review

Conduct Rate Maximization to achieve optimal Hybrid rates

Calls, research and data diagnosis 
HEDIS Non-Production Season


Participate in production debrief activity

Post Production 'Lessons Learned'
Contribute to content for template and local report out
Medical Record Requests and PNLs
Special Handling Calls and PUSH Data Entry
MRR—Medical Record Review- selected E&I plans participate for certain measures
DRG
Systems Testing/User Acceptance /Beta Testing
Complete annual Technical Specifications training
Support state required audits and state reporting
Collaborate with the HEDIS Project Managers in the collection of RFI, ROADMAP and HOQ information for HEDIS
Participate with Regional Quality Team to identify region and or state-specific projects to improve HEDIS scores, CMS Star Ratings and other metrics
Identify opportunities and actively participate in process improvements related to enhancing health plan quality
Assist in developing targeted educational reminders for clinical/preventive initiatives
Other responsibilities as assigned 

Required Qualifications:

Undergraduate degree or demonstrated equivalent experience
Minimum of 2 years Healthcare/Health Plan experience
Experience in medical record review
Experience working with Providers or Vendors; demonstrated ability specific to building relationships and issue resolution
Demonstrated ability to assist with focusing activities toward a strategic direction and achieve targets
Experience with data or project management
Excellent team development skills
Strong interpersonal skills
Excellent time management and prioritization skills
Excellent written and verbal communications skills
Strong proficiency with Microsoft Office applications, including: Word, Excel and PowerPoint
Preferred Qualifications:

Experienced in HEDIS Operations
Minimum of 2 years HEDIS experience and/or knowledge
Solid knowledge of managed care requirements related to clinical quality
Experience working with Providers/Provider Groups
Knowledge of CMS STARs
Experience coordinating work streams across multiple business partners, emphasis on collaboration and issue resolution
Clinical and/or Health Education experience (RN or LPN desired)
Experience working with HEDIS medical record vendors (management, building relationships, issue resolution etc.)
Proficiency with Microsoft Access
Application of continuous quality improvement concepts, such as Six Sigma or PDSA
Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 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: 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.
 
Job Keywords: HEDIS, Clinical Quality, STAR, Chart Reviews, Abstraction, Indexing, Gaps, LPN, RN, Telecommute, Telecommuting, Telecommuting, Remote