For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm)This position is responsible for ongoing HEDIS collection and improvement activities at the health plan and reports to the Quality Management Leader. Primary Responsibilities:Responsible for requesting and managing the review of medical records for HEDIS measures and other projects Support continuum of member care by identifying members in need of health education, case management, etc. Performs on-site medical record reviews by following appropriate procedures for scheduling, requesting and reviewing records while on-site at provider offices and hospitals and prepare additional reports as needed Integrates data collected from a variety of sources including but not limited to the following: medical records, immunization registries, member documents and providers' officesThis position will work in the Falls Church, VA office with the ability to telecommute 2-3 days per week following an orientation period and manager approval.
Required Qualifications: Current unrestricted RN licensure required in Virginia or ability to obtain prior to employment 2+ years clinical experience in any setting (with at least 1 year of acute care) Quality improvement experience (chart review, compliance, HEDIS, investigation, etc.) Experience working in Medicaid and / or Medicare health care and insurance industry, including regulatory and compliance requirements Knowledge of one or more of: clinical standards of care, preventive health standards, HEDIS, NCQA, governing and regulatory agency requirements and the managed care industry Access to reliable transportation that will enable you to travel to client and / or patient sites within a designated area Proficiency in software applications that include, but are not limited to, Microsoft Word, Microsoft Excel, Microsoft Outlook, and Internet browsers Preferred Qualifications: Experience with medical record abstraction processes Managed Care experience Experience in complex populations Bachelor's Degree BilingualCareers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place 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: Registered Nurse, Nurse, RN, INTotal2017, Quality, Quality Improvement, Analyst, Health Care, Medicaid, Medicare, HEDIS, STARS, NCQA, Managed Care, Clinical Practice Consultant, Regulatory Compliance, CMS, Clinical, Project Manager, Falls Church, Virginia, VA, UHC, UnitedHealthcare, Community and State, Public Sector
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.