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 they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.
The Supervisor of Quality Operations is a subject matter expert for the Supplemental Data Entry and Primary Source Verification RNs and LVNs, assisting with growth and development, daily direction and requests as needed. This role assists with the coordination of HEDIS® and STARs data gathering process within EMR systems, DataRAP and additional applications as needed. This role evaluates the quality and completeness of clinical documentation processes by performing quality medical record reviews, assisting in the improvement of the clinical documentation process, maintaining accurate records of review activities, ensuring all data submitted to the health plan meets the HEDIS®/Star technical specifications for medical records. This role assists the Manager of Quality Operations with communication of prioritization, strategy and best practices.
If you are located in CST, EST, or MST, you’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
- Serve as subject matter expert to clinical staff
- Coordinate and account for daily business activities
- Analyze data for possible discrepancies and deficits and document findings
- 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
- Support and improve communications between market and corporate departments
- 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
- Provide expertise to the corporate training department on STAR/HEDIS® measures and on the tools that support the collection of STAR/HEDIS® data
- Assist with team coordination of system changes, and system upgrades
- Develop process improvement
- Perform all other related duties as assigned
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
- Registered Nurse
- 3+ years of HEDIS experience
- 3+ years of experience with data analysis/quality chart reviews
- Knowledge of HEDIS/STAR and Medicare measures
- 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
Preferred Qualifications:
- Bachelor’s degree
- Certified Professional Coder
- 1+ years of team lead, supervisory, or management experience
- Proven ability to be flexible in a continuously changing environment
- Proven excellent training and presentation skills with solid communication capabilities and practices, both oral and written
- All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
Colorado Residents Only: The salary range for this role is $70,200 to $137,800 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.
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.
