Quality Consultant - Remote in CO

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 resources 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.

While working remotely doing scheduled sweeps, going through charts, looking for open gaps, doing outreach measurements for HEDIS GAPs, Follow up with patients needing screenings, doing outreach for ER patient follow ups, close care gap opportunities. Schedule ER, Diabetic follow ups and for external services like Mammograms and colonoscopies we remind and can assist in connecting them. Part of a 12 member team. Using Epic, Touchworks as primary systems and multiple insurance portals. Phone calls, secure messages, a minimum of 10-15 calls per day. Most of calls will be outgoing. Weekly team meetings.

Ideal candidate MA background with at least 2 years of clinic time with HEDIS exp preferred. Excellent phone and communication skills. Be able to handle expedited calls.

This position is responsible for the coordination of HEDIS and STARs data gathering process. This evaluates the quality and completeness of clinical documentation processes by performing quality medical record reviews, assisting in the improvement of the clinical documentation process, identifying trends, maintaining accurate records of review activities, ensures all data submitted to the health plan meets the HEDIS/Star technical specifications for medical records.

This position is full-time. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:00am - 5:00pm MST, Monday - Friday. It may be necessary, given the business need, to work occasional overtime.

This will be on-the-job training. The hours of the training will be aligned with your schedule.

If you are located within the state of Colorado, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• Assisting in the review of medical records to highlight Star/HEDIS opportunities for the medical staff.
• Review medical records for data collection, data entry, and quality monitoring including health plan/Optum form submission and chart collection activities that close gaps in care.
• Partner with the leadership team, the practice administrative or clinical staff to identify trends observed and potential strategies to support the practice.
• Communicate scheduling challenges or trends that may negatively impact quality outcomes.
• Track and trend barriers/challenges that exist at their assigned groups so that better outcomes can be achieved including access to appointments, lack of follow up on referrals, or inconsistent billing practices.
• Activities may include data collection, data entry, quality monitoring, health plan/Optum form submission and chart collection activities.
• Assists with local IRR audits.
• Navigate multiple documentation systems and obtain medical record sections supportive of HEDIS/Star measures.
• Support chart chase process by requesting records from provider's offices as needed.
• Maintains education/knowledge base of HEDIS/STARs.
• 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.

Required Qualifications:

• High School Diploma / GED
• Must be 18 years of age OR Older
• 2+ years of Healthcare experience working in a physician, provider, and/or medical office
• Experience with data analysis/quality chart reviews
• Experienced using Computers and Windows based programs including Microsoft office applications, including databases, word-processing, and excel spreadsheets (create, view, sort, filter)
• Experience working with EMR system
• Ability to work any of our 8-hour shift schedules during our normal business hours of 7:00am - 5:00pm MST, Monday - Friday. It may be necessary, given the business need, to work occasional overtime

Preferred Qualifications:

• Licensed Vocational Nurse or Medical Assistant
• 1+ years of HEDIS/STAR experience or participation with similar regulatory reporting
• Experience in a managed care setting
• ICD 10 and CPT coding experience

Telecommuting Requirements:

• Reside within the state of Colorado
• Ability to keep all company sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

The hourly range for this role is $19.86 to $38.85 per hour based on full-time employment. 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.

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