Unitedhealth Group Inc. Atlanta , GA 30301
UnitedHealthcare's Quality Solutions Delivery (QSD) (formerly 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.
QSD combines talented individuals from many areas of quality, including HEDIS. 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.
In addition to working with the QSD staff, this position will collaborate and work closely with other key areas of quality including HEDIS National Operations, M&R Quality, STARS, CMS/SNP teams and others.
This position reports to the Regional Operations Director.
You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Management of staff 6-8 QSD Specialists
Accountability for improvement of all assigned HEDIS contracts
Advocacy for necessary process improvements uncovered during the chase
Reporting out results during HEDIS season, uncovering missing opportunities, working with field staff/providers/vendors/other LOB
Collaborate with Regional and Executive M&R Leadership
Process improvement projects
Reporting out on project status lots of market presentation responsibilities daily report analysis, rework, and directional shift
Contribute to and/or lead MAC and RQOC presentations
Identifying correct membership in the markets to be included in data collection.
Overseeing project build and QA
Creating opportunities based on data such as piloting 100% QA for a struggling measure
Collaborating with regional teams to map out data collection strategies.
Analysis of prior year results to guide future process
Identifying and leading process improvement initiatives
Identifying alternative sources for administrative data.
Current measure deep dives
Outside the box thinking to reach beyond departmental boundaries to garner resources
Participate in vendor training activities.
Ensuring collection and abstraction changes per tech specs are implemented
Identifying issues through the chase to bring forward for correction (CBP)
Calling out trends
Collaborate with Data and Analytics Team
A HEDIS SME
Identify and implement opportunities for rate improvement
Live Our United Culture everyday! Integrity, Compassion, Relationships, Innovation and Performance
RN or LPN
Experience working with HEDIS software vendors (management, relationship building, issue resolution)
Strong data management and/or project management skills
Demonstrated ability to assist with focusing activities toward a strategic direction and achieve targets
Solid knowledge of managed care requirements related to clinical quality
Centers for Medicare and Medicaid (CMS) Programs
National Committee for Quality Assurance (NCQA) Programs, including HEDIS and CAHPS
State specific Regulatory requirements
Experienced in medical record review
Basic statistical knowledge and application of continuous quality improvement concepts
Strong interpersonal skills
Ability to cultivate and work as a team
Excellent time management and prioritization skills
Excellent written and verbal communications skills
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.
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