Supervisor of Quality Operations RN

4 weeks ago

Lyons, Indiana, United States Optum Full time

Supervisor of Quality Operations RN at Optum summary:
As the Supervisor of Quality Operations RN at Optum, I act as a subject matter expert overseeing data quality and clinical documentation processes while assisting in the coordination of HEDIS and STARs data gathering. My role involves training clinical staff, conducting quality assurance, and maintaining open communication between teams to ensure compliance with health standards. With a focus on improving health outcomes, I leverage my nursing expertise to navigate data systems and uphold best practices within a diverse and inclusive culture.

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start

Caring. Connecting. Growing together.

The

Supervisor of Quality Operations

is a subject matter expert for the Supplemental Data Entry and Primary Source Verification RNs and LVNs, assisting with growth and development, daily direction and requests as needed.

This role assists with the coordination of

HEDIS and STARs

data gathering process within EMR systems, DataRAP and additional applications as needed.

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, ensuring all data submitted to the health plan meets the HEDIS/Star technical specifications for medical records.

This role assists the Manager of Quality Operations with communication of prioritization, strategy and best practices.

If you are located in

CST, EST, or MST,

you'll

enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

Serve as subject matter expert to clinical staff

Coordinate and account for daily business activities

Analyze data for possible discrepancies and deficits and document findings

Perform quality assurance on the data entry and over read 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 scanned records and data entry into supplemental data applications

Support chart chase process by requesting records from provider's offices as needed

Support and improve communications between market and corporate departments

Maintain education/knowledge base of HEDIS/STARs standards and guidelines

Pull and review quality and productivity reporting

Conduct training on HEDIS/STAR measures, HEDIS/STAR data collection software and data collection strategies

Provide expertise to the corporate training department on STAR/HEDIS measures and on the tools that support the collection of STAR/HEDIS data

Assist with team coordination of system changes, and system upgrades

Develop process improvement

Perform all other related duties as assigned

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:

Registered Nurse

3+ years of HEDIS experience

3+ years of experience with data analysis/quality chart reviews

Knowledge of HEDIS/STAR and Medicare measures

Experience using Microsoft office applications, including databases, word-processing, Visio and Excel spreadsheets

Proven excellent training and presentation skills with solid communication capabilities and practices, both oral and written

Access to high speed Internet

Preferred Qualifications:

Bachelor's degree

Certified Professional Coder

1+ years of team lead, supervisory, or management experience

Proven ability to be flexible in a continuously changing environment

Proven excellent training and presentation skills with solid communication capabilities and practices, both oral and written

*All employees working remotely will be

required

to adhere to UnitedHealth Group's Telecommuter Policy

Colorado Residents Only:

The salary range for this role is $70,200 to $137,800 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.

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.

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.

Keywords:
Quality Operations, HEDIS, STARs, Clinical Documentation, Data Analysis, Registered Nurse, Health Outcomes, Quality Assurance, Health Equity, Health Care

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