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LVN HEDIS Quality Consultant In Office in Austin Texas
1 month ago
This position is responsible for the Primary Source Verification process and coordination of HEDIS and STARs data gathering process within the eCW and DataRaps applications. This role evaluates the quality and completeness of clinical documentation processes by performing quality medical record reviews, assisting in the improvement of the clinical documentation process, maintaining accurate records of review activities, ensures all data submitted to the health plan meets the HEDIS/Star technical specifications for medical records.
Primary Responsibilities:
- Analyze data, evaluate for possible data integrity and data deficits and document findings
- Over reads the data entry of non-standard supplemental data obtained from medical record review
- Navigate multiple documentation systems and obtain medical record sections supportive of HEDIS/Star measures
- Review of scanned records and data entry into DataRaps application
- Support chart chase process by requesting records from provider's offices as needed
- Supports and improves communications between market and corporate departments
- Maintains education/knowledge base of HEDIS/STARs standards and guidelines
- Performs all other related duties as assigned
Required Qualifications:
- Licensed Vocational/Professional Nurse
- 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
- HEDIS/STAR experience or participation with similar regulatory reporting
- This position requires Tuberculosis screening as well as proof of immunity to Measles, Mumps, Rubella, Varicella, Tetanus, Diphtheria, and Pertussis through lab confirmation of immunity, documented evidence of vaccination, or a doctor's diagnosis of disease
- 2+ years of college, in pursuance of a Bachelor's or Associate's degree
- 2+ years of experience working with HEDIS/STAR measures
- Ability to push or pull heavy objects using up to pounds of force
- Ability to properly drive and operate a company vehicle
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.
