Quality Operations Supervisor RN

5 days ago


Oklahoma City, Oklahoma, United States UnitedHealth Group Full time
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives.

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.

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
Requirements:
  • 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

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.



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