What can YOU do with the right information? At OptumInsight, the possibilities and the impact are limitless. You'll be empowered to ask more questions, develop better solutions and help make the health care system greater than ever. It's always fresh. It's always exciting.
As CQO Clinical Lead you'll provide leadership and oversight to strengthen and improve health care operations that result in stronger financial returns and a healthier health care system. You'll use your strong strategic and business acumen to develop and implement key components related to the HEDIS clinical abstraction process to ensure critical deliveries are executed. This career gives you the opportunity to share in a mission that inspires. You'll see your ideas come to life and your achievements recognized. You won't find tougher challenges. And you won't find smarter people working together to solve them. Join us and start doing your life's best work.(sm)
The Leader in this position will provide clinical expertise to abstraction teams for HEDIS Supplemental and Chart Chase. They will be responsible for quality audits, individual quality monitoring, participating in training, building training and support materials for abstractors and clients. In addition, they will provide essential support with reporting and audit submission
- Participate in HEDIS audits
- Participate in the development of HEDIS Medical Record Review training materials
- Participate in training resources and clients on HEDIS medical record review
- Experience working in a matrix environment
- Serve as the Subject Matter Expert of NCQA’s HEDIS Technical Specifications for all HEDIS Hybrid Measures
- Provide leadership and insight related to the MRR Vendor Training Programs and Policies and Procedures
- Ensure Quality Assurance (QA) standards are met at the measure level through vigorous oversight and Inter-Rater Reliability (IRR) of chart abstractions performed on behalf of the client by MRR Vendors
- When quality issues are identified, work hand in hand with the vendor to close the gap and ensure that quality assurance levels return to expected levels of acceptability
- Conduct oversight of numerator positive charts selected for MRRV Audit
- Provide leadership in the HEDIS MRRV chart preparation and submission preparation for HEDIS Auditor
- Participate in correction of any and all errors identified as part of the MRRV Audit to ensure all errors are corrected and re-submitted timely
- Assist in managing customer expectations, and provide critical feedback to software development personnel
- Provide strategic support in preparation of the HEDIS Roadmap, HOQ, and HEDIS audit.
- Provide feedback related to annual system updates for MRR abstraction tool as result of specification changes and/or process enhancements
- Point of contact for HEDIS auditors for system demos and onsite interviews
- Participate in developing / pulling reporting documents for progress and results of abstraction
- Less than 10% Travel
- Clinical Licensure such as LPN, RN, RRT, etc.
- 2+ years of HEDIS experience, performing a wide range of functions with strong focus on medical record review/abstraction and clinical oversight
- 2+ years of experience in a health care delivery organization
- 2+ years of Quality Audit and/or abstraction experience
- 1+ years of experience working with vendors
- 1+ years of training experience
- Knowledgeable of current trends in HEDIS in managed health care.
- Knowledgeable of NCQA, Stars, HEDIS, HOS and CAHPS requirements.
- Familiarity with Value Sets ICD-9-CM, CPT, DRG, LOINC, HCPCS, TOB, POS, NDC coding
- Experience producing job aides
- Proficient with MS Office (Excel, Word, PowerPoint), Adobe Acrobat & SnagIt
- Proficiency in presentation skills to audiences of various sizes
- Knowledge of Medicaid and/or Medicare programs
- Associate’s degree
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)
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: CQO Clinical Training Lead, Eden Prairie, MN, Minnesota, Telecommute, Remote, Work from Home