Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life’s best work.(sm)
This position is responsible for the coordination of HEDIS and STARs data gathering process within the clinic setting. This role is responsible for the education to the clinic on quality measures and coordinates strategies for closing gaps. 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, developing formal training and improvement programs and maintaining up-to-date knowledge of regulatory (HEDIS/STARs) standards and guidelines.
- Analyze data, evaluate for possible data integrity and data deficits and document findings
- Analyze and trend HEDIS/STAR rates, identify barriers to improvement of rates and create interpretive exhibits
- Obtains quality detail report and flags patient’s charts with the missing measures
- Works closely with local leadership to execute quality strategies
- Supports and assists PCPs/clinics with quality data collection
- Provides reports and monitors performance at local level
- Engages PCP and clinic staff in developing strategies to close quality gaps
- Supports and improves communications between market and corporate departments
- Maintains education/knowledge base of HEDIS/STARs standards and guidelines
- Performs 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.
- Licensed Vocational/Professional Nurse
- 3+ years of healthcare experience to include experience in a managed care setting
- 3+ years of experience with data analysis/quality chart reviews. Must be able to review data and provide recommendations for improvement
- HEDIS/STAR experience or participation with similar regulatory reporting
- Experienced using Microsoft office applications, including databases, word-processing, and excel spreadsheets
- 50-75% local travel
- This position requires Tuberculosis screening as well as proof of immunity to Measles, Mumps, Rubella, Varicella, Tetanus, Diphtheria, and Pertussis through lab confirmation of immunity, documented evidence of vaccination, or a doctor's diagnosis of disease
- Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation
- 2+ years of college, in pursuance of a Bachelor’s or Associate’s degree
- 2+ years of experience working with HEDIS/STAR measures
Physical & Mental Requirements:
- Ability to lift up to 25 pounds
- Ability to sit for extended periods of time
- Ability to stand for extended periods of time
- Ability to use fine motor skills to operate office equipment and/or machinery
- Ability to receive and comprehend instructions verbally and/or in writing
- Ability to use logical reasoning for simple and complex problem solving
To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment
Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 550,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)
WellMed was founded in 1990 with a vision of being a physician-led company that could change the face of healthcare delivery for seniors. Through the WellMed Care Model, we specialize in helping our patients stay healthy by providing the care they need from doctors who care about them. We partner with multiple Medicare Advantage health plans in Texas and Florida and look forward to continuing growth.
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.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.