Clinical Quality Coordinator

Company: UnitedHealth Group
Location: Sahuarita
Posted on: May 24, 2023

Job Description:

Do you have a passion to transform healthcare and millions of lives as a result? This starts with the values you embrace and the passion you bring to achieve your life's best work.(sm)

The Clinical Quality Coordinator 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.

Position can be based in Phoenix or Tucson, AZ

$1500 Sign on Bonus for External Candidates

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
  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 or GED
  • 3+ years of healthcare experience
  • 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
    
    Preferred Qualifications:
    • 2+ years of college, in pursuance of a Bachelor's or Associate's degree
    • 3+ years of experience with data analysis/quality chart reviews - ability to review data and provide recommendations for improvement
    • Licensed Practical/Registered Nurse or Certified Professional Coder
    • 2+ years of experience working with HEDIS/STAR measures
    • 1+ years of HEDIS/STAR experience or participation with similar regulatory reporting
    • Experienced using Microsoft office applications, including databases, word-processing, and excel spreadsheets
    • ICD 10 and CPT coding experience
    • Experience working in a physician, provider, and/or medical office
    • EMR and HEDIS knowledge and experience
      
      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 Optum. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges.
      
      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.
      
      

Keywords: UnitedHealth Group, Tucson , Clinical Quality Coordinator, Healthcare , Sahuarita, Arizona