Opportunities at WellMed, part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinical staff and non-patient-facing roles, you can make a difference with us as you discover the meaning behind Caring. Connecting. Growing together.
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
Experience using Microsoft office applications, including databases, word-processing, and excel spreadsheets
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
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
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.