Clinical Quality Manager - Telecommute

Talk about meaningful work. Talk about an important role. Let's talk about your next career move. Delivering quality care starts with ensuring our processes and documentation standards are being met and kept at the highest level possible. This means working behind the scenes ensuring a member-centric approach to care. As a Senior Quality Analyst you will monitor and support health plan quality improvement initiatives with particular emphasis on compliance with state and federal regulatory and accreditation requirements. You'll act as a voice for our members, guiding the development of comprehensive care plans that will help others live healthier lives. Here's your opportunity to discover 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. Generally work is self-directed and not prescribed. Individual will work with more complex issues and serve as a resource to others. Individual must be highly organized, possess strong leadership skills, with demonstrated professional maturity and emotional resilience. Exhibits creative problem solving skills, adapting approach as needed for each engagement.
Primary Responsibilities:
HEDIS Production Season



Manage Temporary staff hired to support production, aka, hybrid chart chase

Participate in interviewing and hiring
Support onboarding and training
Conduct additional trainings as needed based on staff need

Pull Vendor Pend List, and create work list for contractor

Assign vendor pend list to Administrative contractors
Review List from Administrative contractors
Respond/work with the Administrative contractors on vendor pends
Work high complexity pends
Conduct outreach with difficult Providers
Childhood Immunization Look up
Support Internal collection activities, i.e., Eye, Lab, Hepatitis B

Limited Abstraction/Data Entry support

Conduct over read of medical charts to assess member’s compliance with HEDIS measure
Pull medical records via remote electronic medical record retrieval system

Vendor Oversight at the Project/Market level

Attend Meetings
Support pend resolution
Run reports
Manage special handling
Orphan/Unlinked member research and QA Review
Identify opportunities for Rate Maximization to achieve optimal Hybrid rates  
HEDIS Non-Production Season


Lead and/or participate in production debrief activity

Post Production 'Lessons Learned'
Create 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 and implement 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 
***This position can be located at any UnitedHealth Group location in the U.S.***

Required Qualifications:

Undergraduate degree
Minimum of 4 years Healthcare/Health Plan experience
Minimum of 2 years HEDIS experience and/or medical record review
Minimum of 1 year of experience working with HEDIS vendors, demonstrated ability specific to management, building relationships, issue resolution etc
Solid knowledge of managed care requirements related to clinical quality
Demonstrated ability to assist with focusing activities toward a strategic direction and achieve targets
Adaptable to a highly changing environment; ability to quickly shift focus as priorities change
Build trust and form effective relationships with stakeholders by providing timely operational updates, partnering on issue resolution/mitigation strategies
Strong data management and/or project management skills
Demonstrated ability to assist with focusing activities toward a strategic direction and achieve targets
Excellent team development skills
Excellent time management and prioritization skills
Communicate effectively and persuasively, excellent interpersonal and communication skills, both written and verbal
Strong proficiency with Microsoft Office applications, including: Word, Excel and PowerPoint
Preferred Qualifications:

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)
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, CMS, STAR, RN, LPN, Six Sigma, PDSA, telecommute, telecommuting, telecommuter