At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.
Our Quality Reporting Operations team is vital to our success and driving the future growth of UnitedHealth Group. Success in these careers relies on many factors - your ability 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 work remotely
- 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 reportingMonitor 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 stateEnsure all business requirements are metDemonstrate 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 databasesSubmission 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) on complex projectsPerform SDS, administrative refresh data loads and vendor medical record event data loads to the hybrid project and update ratesPerform all MRR project build steps, including QA, to ensure each hybrid MRR project is set up according to business requirementsCoordinate with medical record vendors on file loads and resolving technical project issuesConfirmation of all hybrid exclusions entered into HEDIS software, coordinating clinical review when necessaryComplete all HEDIS software upgrade steps as requiredCreate and validate all final hybrid frozen counts and deliver to CHCAComplete all final hybrid project close steps, including validation of all exclusions and QA of all final data and ratesComplete all final admin and hybrid project processingCreation of IDSS exports and submission to NCQACreation of PLD exports and submission to CHCA and / or CMSSubmission of State required reporting if applicableCoordinate efforts with the LOB Operations team to ensure all business requirements and deliverables are metMay also assist in supporting chase status updates, chase activations, query exports and special request data analysis or validationMonitor and 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 opportunitiesParticipate 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 requirementsParticipate in HEDIS software system testing efforts to ensure project preparednessUse a process driven approach to identify root cause and process improvement opportunitiesDemonstrate and remain current in understanding of relevant regulations and systemsComplete 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 specificationsGeneral knowledge of HEDIS impacts for each LOB, i.e. Accreditation, STARs, FEHB, State, etc.Summarize and communicate proposed solutions with the appropriate audiencesResolve all CHCA (Auditor) Issue Log concerns for projects assigned
Communicate potential impacts and risks associated with implementing proposed solutions to business partners and relevant stakeholdersTimely escalation of all issues and barriers to Manager, QOI Projects (MQP)
Assesses and interprets customer needs and requirementsIdentifies solutions to non-standard requests and problemsSolves moderately complex problems and / or conducts moderately complex analysesWorks with minimal guidance; seeks guidance on only the most complex tasksTranslates concepts into practiceProvides explanations and information to others on difficult issuesCoaches, provides feedback, and guides othersActs as a resource for others with less experienceYou'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 :
3+ years of experience in analysis and reporting2+ years HEDIS or CMS stars experienceExperience interpreting and analyzing large amounts of data from multiple sourcesHealthcare experienceIntermediate proficiency in MS ExcelProven excellent communication, time / project management, problem solving, organizational, and analytical skillsDemonstrated ability to manage and prioritize deliverablesPreferred Qualifications :
Experience creating reportsProficient in use of certified HEDIS softwareAdvanced proficiency in MS ExcelCompetencies
Integrity Value : Act EthicallyComply with Applicable Laws, Regulations and Policies
Demonstrate IntegrityCompassion Value : Focus on CustomersIdentify and Exceed Customer Expectations
Improve the Customer ExperienceRelationships Value : Act as a Team PlayerCollaborate with OthersDemonstrate Diversity Awareness
Learn and DevelopRelationships Value : Communicate EffectivelyInfluence Others
Listen ActivelySpeak and Write ClearlyInnovation Value : Support Change and InnovationContribute Innovative Ideas
Work Effectively in a Changing EnvironmentPerformance Value : Make Fact-Based DecisionsApply Business Knowledge
Use Sound JudgementPerformance Value : Deliver Quality ResultsDrive for Results
Manage Time EffectivelyProduce High-Quality WorkAll employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter PolicyPay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $71,200 to $127,200 annually based on full-time employment. We comply with all minimum wage laws as applicable.
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.