Clinical Quality RN - Remote - #1407419
Lensa
Date: 1 week ago
City: Eden Prairie, MN
Contract type: Full time
Remote

Lensa is the leading career site for job seekers at every stage of their career. Our client, UnitedHealth Group, is seeking professionals. Apply via Lensa today!
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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.
The Clinical Quality RN is a subject matter expert for Primary Source Verification and Supplemental Data Entry. They assist with the coordination of HEDIS and STARs data gathering within Cozeva, DataRAP and other applications as needed. This role evaluates the quality and completeness of clinical documentation, by performing quality medical record reviews, assisting in the improvement of the clinical documentation process, maintaining accurate records of review activities, ensuring all data submitted to the health plan meets the HEDIS/Star technical specifications for medical records. This role assists the Supervisor of Quality Operations with over reads and quality assurance checks.
You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities
Required Qualifications
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.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.
The Clinical Quality RN is a subject matter expert for Primary Source Verification and Supplemental Data Entry. They assist with the coordination of HEDIS and STARs data gathering within Cozeva, DataRAP and other applications as needed. This role evaluates the quality and completeness of clinical documentation, by performing quality medical record reviews, assisting in the improvement of the clinical documentation process, maintaining accurate records of review activities, ensuring all data submitted to the health plan meets the HEDIS/Star technical specifications for medical records. This role assists the Supervisor of Quality Operations with over reads and quality assurance checks.
You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities
- Review and abstract medical record data into appropriate application(s)
- Primary source verify abstracted medical record data
- Over read abstracted and verified medical record data
- Analyze chart data, evaluate for possible data integrity and/or data deficits and document findings
- Provide education and feedback to primary source verifiers and/or abstractors
- Support chart chase processes by requesting records from provider offices as needed
- Navigate multiple documentation systems and obtain medical record sections supportive of HEDIS/Star measures
- Support and improve communications between market and corporate departments
- Maintain education/knowledge base of HEDIS/STARs standards and guidelines
- Assist with process improvement
- Performs all other related duties as assigned
Required Qualifications
- Active and unrestricted licensure as a Registered Nurse (RN) in the state(s) of practice
- 3+ years of experience with data analysis/quality chart reviews. Must be able to review data and provide recommendations for improvement
- 2+ years of HEDIS/STAR experience
- Experience using Microsoft office applications, including databases, word-processing, and Excel spreadsheets
- Excellent communication practices, both oral and written
- Undergraduate degree
- Certified Professional Coder
- 1+ years of process improvement experience
- Experience in training and excellent presentation skills
- Ability to be flexible in a continuously changing environment
- Ability to lift up to 25 pounds
- Ability to sit for extended periods of time
- Ability to use fine motor skills to operate office equipment and/or machinery
- Ability to receive and comprehend instructions verbally and/or in writing
- Ability to use logical reasoning for simple and complex problem solving
- All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
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.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
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