Clinical Quality RN - Telecommute in EST or CST Time Zones
Location: Minnetonka, Minnesota
Internal Number: 107173378
Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm)
The Clinical Quality RN is a subject matter expert for Primary Source Verification and Supplemental Data Entry. They assist with the coordination of HEDIS® and STARs data gathering within Cozeva, DataRAP and other applications as needed. This role evaluates the quality and completeness of clinical documentation, 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 Supervisor of Quality Operations with over reads and quality assurance checks.
If you are located in EST or CST, Time Zones, you will have the flexibility to telecommute* as you take on some tough challenges.
Review and abstract medical record data into appropriate application(s)
Primary source verify abstracted medical record data
Over read abstracted and verified medical record data
Analyze chart data, evaluate for possible data integrity and/or data deficits and document findings
Provide education and feedback to primary source verifiers and/or abstractors
Support chart chase processes by requesting records from provider offices as needed
Navigate multiple documentation systems and obtain medical record sections supportive of HEDIS/Star measures
Support and improve communications between market and corporate departments
Maintain education/knowledge base of HEDIS®/STARs standards and guidelines
Assist with process improvement
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.
3+ years of experience with data analysis/quality chart reviews. Able to review data and provide recommendations for improvement
2+ years of HEDIS®/STAR experience
Experience using Microsoft office applications, including databases, word-processing, and Excel® spreadsheets
Certified Professional Coder
1+ years of process improvement experience
Experience in training and excellent presentation skills
Ability to be flexible in a continuously changing environment
Excellent communication practices, both oral and written
Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance
Physical and Mental Requirements:
Ability to lift up to 25 pounds
Ability to sit 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 now require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles require full COVID-19 vaccination 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 Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)
Colorado, Connecticut or Nevada Residents Only: The hourly range for Colorado residents is $21.68 to $38.56. The hourly range for Connecticut/Nevada residents is $23.94 to $42.40. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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.
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
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: Clinical Quality RN, RN, HEDIS, STARS, Extraction, Telecommute, Telecommuting, Telecommuter, Work From Home, Work At Home, Remote, Central Time, CST, EST, Eastern Time