San Antonio, Texas
Walnut Creek, California
Posted: 30-Aug-24
Location: San Antonio, Texas
Salary: Open
Internal Number: 141881310
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 to start Caring. Connecting. Growing together.
This position is responsible for the coordination of HEDIS and STARs data. This role is responsible for education to the patient on quality measures and coordinates strategies for closing gaps. The Quality Coordinator LVN, through telephonic outreaches will educate patients on CAHPS & HOS components while working to close other HEDIS gaps for patients. Evaluates the quality and completeness of clinical gap closures by performing quality reviews with patients, maintaining clinical documentation, and accurately records of their review activities. The Quality Coordinator LVN will maintain up-to-date knowledge of regulatory (HEDIS/STARs) standards and guidelines.
Primary Responsibilities:
- Analyze data, evaluate for possible data integrity and data deficits and document findings
- Analyze and trend HEDIS/STAR rates, identify barriers to improvement of rates and create interpretive exhibits
- Identifies patients with the missing measures and works to close the measures through education/counseling, appointment setting, and other means as appropriate
- Conduct a high volume of outbound calls to members to discuss reasons for non-compliant to medication(s), schedule pharmacy telephonic appointments, and/or obtain important follow up information from providers. Outbound calls are made primarily using an auto dialer requiring precision to
- detail and adaptability to type of response needed
- May answer inbound calls from members and assists them with their inquiries. Routes calls to appropriate department if necessary
- Follows system scripting and validates member demographic information
- Documents the provider or member's record with accurate information obtained on the call
- Works closely with local leadership to execute quality strategies
- Supports and assists PCPs/clinics with quality data collection
- Provides reports and monitors performance at local level
- Engages PCP and clinic staff in developing strategies to close quality gaps
- Maintains education/knowledge base of HEDIS/STARs standards and guidelines
- Performs all other related duties as assigned
This is an office-based position located near Interstate Highway I-10 West, near West Frontage Road just past The Rim Shopping Center/Ferrari Dealership, 78257
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:
- Licensed Vocational/Professional Nurse
- HEDIS/STAR experience or participation with similar regulatory reporting
- 3+ years of healthcare experience to include experience in a managed care setting
- 3+ years of experience with data analysis/quality chart reviews. Must be able to review data and provide recommendations for improvement
- Experienced using Microsoft office applications, including databases, word-processing, and excel spreadsheets
Preferred Qualifications:
- 2+ years of college, in pursuance of a Bachelor’s or Associate’s degree
- 2+ years of experience working with HEDIS/STAR measures
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.
Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
