Clinical Quality LPN - Remote
About The Position
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 LPN is responsible for Primary Source Verification and Supplemental Data Entry. They assist with the coordination of HEDIS® and STARs data gathering within Pathway, Ubiquity, XLCare, eHouseCalls, 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 supports end of year final push activities, as well as hybrid chart chase processes. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week. Schedule: Monday - Friday, 8:00 a.m. - 5:00 p.m. in your time zone
Requirements
- Licensed Professional/Vocational Nurse
- 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 or participation with similar regulatory reporting
- Proven excellent communication practices, both oral and written
- Experience using Microsoft office applications, including databases, word-processing, and Excel spreadsheets
- All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
Nice To Haves
- Associate degree
- Undergraduate degree or equivalent experience
- Certified Professional Coder
- Training experience
- Ability to be flexible in a continuously changing environment
Responsibilities
- Review and abstract medical record data into appropriate application(s)
- Support chart chase processes by requesting/obtaining records as needed
- Primary source verify abstracted medical record data
- Analyze chart data, evaluate for possible data integrity and/or data deficits and document findings
- Provide education and feedback to abstractors
- Navigate multiple documentation systems and obtain medical record sections supportive of HEDIS/Star measures
- Support chart chase processes by requesting records from provider offices as needed
- Support member outreach campaigns within the H&C organization, as needed
- Maintain education/knowledgebase of HEDIS®/STARs standards and guidelines
- Assist team with re-training
- Perform all other related duties as assigned
Benefits
- a comprehensive benefits package
- incentive and recognition programs
- equity stock purchase
- 401k contribution
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
