UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm)
Our Quality & Value Solutions Delivery (QVSD) Quality Reporting Operations (QRO) groups are vital to our success and are leaders in driving the future growth of UnitedHealth Group. Success in these careers relies on many factors: your abilities to deal with ambiguity, your ability to adapt and embrace change, and a long-term commitment to making health care better for everyone.
You'll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
- Facilitate, oversee, and monitor on-going business processes to support HEDIS® data reporting
- Monitor compliance against relevant process requirements (e.g., turnaround time, accuracy)
- Evaluate processes and outcomes against benchmarks and metrics and identify potential business impacts of current state
- Demonstrate understanding of relevant organizations' operations, products and applications, strategies, processes, and/or business priorities to build effective solutions including development of project plans (e.g., communication plans; implementation steps) to support operations using relevant tools and databases
- Completion of the Optum RFI to define HEDIS® reporting requirements
- Submission of the NCQA Health plan Roadmap General Information, Appendix and Attestation
- Submission of the NCQA Healthcare Organization Questionnaire (HOQ)
- Complete admin and hybrid measure benchmarking and rate review to resolve all CHCA (Auditor) rate outlier concerns throughout the HEDIS® project (Initial, Refresh, Final)
- Perform SDS, administrative refresh data loads and vendor medical record event data loads to the hybrid project and update rates
- Perform all MRR project build steps, including QA, to ensure each hybrid MRR project is set up according to business requirements
- Complete project chase status updates, chase activations, query exports and data analysis to support rate improvement and project completion
- Coordinate with medical record vendors on file loads and resolving technical project issues
- Confirmation of all hybrid exclusions entered into HEDIS® software, coordinating clinical review when necessary
- Complete all HEDIS® software upgrade steps as required
- Create and validate all final hybrid frozen counts and deliver to CHCA
- Complete all final hybrid project close steps, including validation of all exclusions and QA of all final data and rates
- Complete all final admin and hybrid project processing
- Creation of IDSS exports and submission to NCQA
- Creation of PLD exports and submission to CHCA and/or CMS
- Submission of State required reporting
- Collaborate with Optum partners to ensure all supplemental data submissions (SDS) files are obtained for State Registries
- Coordinating look-up access activities for State Registries where data files must be supplemented in hybrid efforts
- Coordinate efforts with the LOB Operations team to ensure all business requirements and deliverables are met
- Analyze business process information (e.g., metrics; analytics) to identify key issues, trends, and potential root causes (e.g., training issues; lack of understanding by user community) that point to improvement opportunities
- Participate in analysis of project outcomes to generate data driven recommendations for process improvement
- Lead and participate in workgroups to implement process improvement and/or in preparation to meet business requirements
- Participate in HEDIS® software system testing efforts to ensure project preparedness
- Use a process driven approach to identify root cause and process improvement opportunities
- Demonstrate and remain current in understanding of relevant regulations and systems
- Complete all required training for job role and stay current on all HEDIS® technical specifications and software systems
- Develop proficiency in HEDIS® software tools and HEDIS® and other required quality metric reporting specifications
- General knowledge of HEDIS® impacts for each LOB, i.e. Accreditation, STARs, FEHB, State, etc.
- Summarize and communicate proposed solutions with the appropriate audiences
- Resolve all CHCA (Auditor) Issue Log concerns for projects assigned
- Communicate potential impacts and risks associated with implementing proposed solutions to business partners and relevant stakeholders
- Timely escalation of all issues and barriers to Manager, QSD Projects (MQP)
- Assesses and interprets customer needs and requirements
- Identifies solutions to non-standard requests and problems
- Solves moderately complex problems and/or conducts moderately complex analyses
- Works with minimal guidance; seeks guidance on only the most complex tasks
- Translates concepts into practice
- Provides explanations and information to others on difficult issues
- Coaches, provides feedback, and guides others
- Acts as a resource for others with less experience
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:
- Bachelor's Degree or equivalent experience
- 3+ years of experience in analysis and reporting
- 2+ years of HEDIS® or CMS stars experience
- Experience with interpreting and analyzing large amounts of data from multiple sources
- Healthcare experience
- Intermediate proficiency in MS Excel
Preferred Qualifcations:
- Proficient in certified HEDIS® software
- Experience with creating reports
- Excellent communication, time/project management, problem solving, organizational, and analytical skills
- Demonstrated ability to manage and prioritize deliverables
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 at UnitedHealthcare Medicare & Retirement. The Boomer generation is the fastest growing market segment in health care. And we are the largest business in the nation dedicated to serving their unique health and well-being needs. Up for the challenge of a lifetime? Join a team of the best and the brightest to find bold new ways to proactively improve the health and quality of life of these 9 million customers. You'll find a wealth of dynamic opportunities to grow and develop as we work together to heal and strengthen our health care system. Ready? It's time to do your life's best work.(sm)
Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $66,100 to $118,300. The salary range for Connecticut / Nevada residents is $72,800 to $129,900. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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.
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.