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We have modest goals: Improve the lives of others. Change the landscape of health care forever. Leave the world a better place than we found it. Such aspirations tend to attract a certain type of person. Crazy talented. Compassionate. Driven. To these individuals, we offer the global reach, resources and can-do culture of a Fortune 5 company. We provide an environment where you’re empowered to be your best. We encourage you to take risks and in return, offer a world of rewards and benefits for performance. Exceeding your limits is an exceptional start to your life's best work.SM


Just like you, we are driven by a set of fundamental principles that are guiding our way forward. Our values of integrity, compassion, relationships, innovation, and performance serve as a foundation to transform health care. Are you in? Learn more about your future at UnitedHealth Group at careers.unitedhealthgroup.com


Job Category:

Medical and Clinical Operations



Approximate Salary:

Not Specified

Position Type:

Full Time

Quality Solutions Delivery Specialist - Telecommute

UHG - Chicago, Illinois

Posted: 12/10/2018

The Quality Solutions Delivery Specialist will be responsible for ongoing management and operational support to dedicated markets / reporting populations to achieve HEDIS® results.      


This role will be responsible for ongoing management of market/reporting population specific quality measures. The Quality Solutions Delivery Specialist will work in partnership with the market-level quality director to strategically increase HEDIS®, CMS STARs and state- specific measure performance scores by monitoring, measuring and reporting on key metrics to meet or exceed quality standards, contractual requirements and pay for performance incentives.  This role is dedicated to Quality Solutions Delivery.


Individual must be highly organized, possess strong leadership skills, with demonstrated professional maturity and emotional resilience. Day to day work varies based on time of year, with overarching goal to increase collection of member compliant information resulting in improved HEDIS® rates. The core work during HEDIS® collection season includes oversight of medical record collection and abstraction, collaboration with Vendor Management, complete non-compliant review, and rate maximization.


You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.


Primary Responsibilities:

  • Responsible to understand and apply knowledge to support and deliver HEDIS ®/ CMS measure proficiency at a market or reporting population level
  • Completion of all required measure-level training
  • Reporting and monitoring trends to improve HEDIS® and HEDIS®-like state specific measures
  • Manages and evaluates HEDIS® collection project progress and results to meet financial and timeline targets/goals
  • Coordinates and performs medical record collection (onsite or via remote access) to support HEDIS® activities or to investigate gaps in clinical documentation for performance improvement Employs a priority measure approach to HEDIS® data collection and gap closure 
  • Medical record abstraction and data entry support, as needed
  • Outreach to provider offices to support timely and complete medical record retrieval during production season and gap closure during the pre-season
  • Oversight of vendor activities
  • Identify / participate in pre-season (non- hybrid season) data collection activities and regional or state-specific projects to identify operational improvements, trends in performance, other opportunities to improve HEDIS® scores, CMS Star Ratings and other metrics
  • Collaborate with the Quality Solutions Delivery Project Managers in the collection of RFI, ROADMAP and HOQ information for HEDIS®
  • Builds trust and forms effective relationships with stakeholders by providing timely operational updates, partnering on issue resolution/mitigation strategies, and monitors resolution of identified issues to conclusion
  • Educates providers on proper clinical documentation, coding, and billing practices,  CMS mandated quality metrics specifications, provider profiling and pay for performance measurement, and medical record review criteria, to drive quality improvement
  • Exhibits creative problem solving skills, adapting approach as needed for each engagement
  • Demonstrates adaptability in a highly changing environment, quickly shifting focus as priorities change

Required Qualifications:

  • Undergraduate degree
  • 2+ years direct HEDIS® and / or medical record review experience
  • 4+ years Healthcare industry or managed care experience
  • Intermediate level of proficiency with Microsoft Word, Excel and PowerPoint

Preferred Qualifications:

  • Clinical and/or Health Education experience (RN or LPN desired)
  • Experience working with provider offices (clinician and non-clinicians)
  • Knowledge of CMS STARs
  • Experience using Microsoft Visio, SharePoint
  • Project management experience
  • Application of continuous quality improvement concepts, such as Six Sigma or PDSA
  • Demonstrated ability to meet commitments, build consensus, negotiate resolutions, and garner respect from other teams
  • Demonstrated ability to assist with focusing activities toward a strategic direction and achieve targets /goals
  • Demonstrated ability to meet commitments, build consensus, negotiate resolutions, and garner respect from other teams

Soft Skills:

  • Effective interpersonal and communication skills, both written and verbal
  • Energy, motivation, and commitment to drive to results in a challenging, fast-paced environment
  • Diplomatic with strong negotiation and conflict resolution 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)   


*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy



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: RN, Registered Nurse, LPN, Health Education, Clinical Review, Quality Improvement, Process Improvement, Performance Improvement, Auditing, Health Care Analytics, Managed Care, Healthcare, HEDIS®, STARs, NCQA, Project Management, Population Health Management, Six Sigma, PDSA,  Chicago, Atlanta, Dallas, Orlando, New York, IL, Illinois,GA, Georgia, AZ, Arizona, TX, Texas, NY, New York, Telecommute, Work from Home, UHG, UHC, UnitedHealthcare

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