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. Bring your skills and talents to a role where you'll have the opportunity to make an impact on a huge scale. This is the place to do your life's best work.(sm)
The Clinical Quality Analyst (Stars Network Performance Specialist) works to improve quality and recommend process improvements. The Stars Network Performance Specialist assists the Stars Network Performance Team, Revenue Cycle Management (RCM) team and the Network Management Services (NMS) team in support of comprehensive business operations to increase Star rating goals. Primary duties include physician Stars education and acting as a liaison between Plan and provider as it relates to Stars. Under general direction, the Stars Network Performance Specialist is responsible for assisting in the daily operations of the Stars Network Department with all duties including, but not limited to, the responsibilities outlined below. This role will require daily travel to providers' offices in Broward and Miami/Dade counties.
- Perform group and individual training session according to the CMS Stars technical specs
- Analyze provider Stars Non-Compliant List, Scorecards and other Stars reports to identify areas with opportunity
- Accountable for the process of the provider to reach Star rating goals
- Accountable for meeting monthly provider visit goal
- Liaison between provider and health plan to achieve provider, group and plan rating
- Share/educate provider on HEDIS tools and resources
- Review/recommend provider STARS/HEDIS coding practices for optimal outcomes
- Analyze work processes and identify areas where procedures and quality could be improved
- Audits medical records to assure proper coding of submitted claims, and analyze provider gaps
- Educates providers on proper documentation & coding for HEDIS compliance
- Works closely with other departments (Finance, NMS and RCM) on provider progress/challenges
- Flexibility in performance of work assigned in order to meet goals
You can be a part of this team. You can put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered. This position will work in office and the incumbent will report to the Miami-Dade office when not traveling in the field. There is approximately 75% travel in Miami-Dade and Broward Counties.
- Undergraduate degree or equivalent experience (Working in managed care in a quality environment)
- 2+ years of experience developing and implementing performance improvement projects or using data to develop intervention strategies to improve outcomes
- 2+ years of managed care experience
- Experience related to quality improvement / performance outcomes such as: HEDIS, STARS, NCQA and CAHPS/HOS
- Intermediate experience with MS Office including Word, Excel, Outlook, and PowerPoint
- Prior experience in large, multi-function and cross geographic organizations
- Bilingual ( English and Spanish) Strongly Preferred
- Coding and medical record abstraction experience Strongly Preferred
- Strong organizational skills and ability to work both independently and with teams
- Ability to evaluate medical records with attention to detail
- Ability to use databases and prepare reports as needed
- Ability to organize and coordinate group meetings
- Intermediate level skills interpreting data and making process improvement recommendations after data analysis
- Ability to collect, analyze and present data
- Excellent verbal and written communication skills
If the hired individual resides in Florida (office based or telecommuting) this position requires the AHCA Level II background check (fingerprinting) by the State of Florida for all clinicians that have direct face to face contact with members OR employees who will have access to confidential patient data and will require renewal every five years.
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
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: Quality Analyst, Clinical Quality Analyst, Analyst, Project Manager, Project Management, Analysis, Data Analysis, UnitedHealth Group, UHG, UHC Miami, Miami Dade, Broward, Florida, FL