Clinical Quality Specialist

7 days ago


Sandia Park, New Mexico, United States Optum Full time
Optum Clinical Quality Coordinator Job Description

At Optum, we're dedicated to delivering care and improving health outcomes for millions of people worldwide. As a Clinical Quality Coordinator, you'll play a vital role in our mission by working collaboratively with our market team to drive quality improvement initiatives in your assigned territory.

This full-time position requires flexibility to work various 8-hour shift schedules during our normal business hours of 8:00am - 5:00pm. Occasional overtime may be necessary. Our office is located in Albuquerque, NM.

Key Responsibilities:
  • Conduct medical record reviews, data collection, and quality monitoring to identify areas for improvement and enhance Star/HEDIS performance.
  • Partner with Clinical Quality, Network Management, and Risk Education teams to analyze trends and develop strategies to support assigned practices.
  • Track and trend barriers and challenges within your assigned territory to inform data-driven decisions.
  • Navigate multiple documentation systems (EMRs) to obtain medical records and improve quality and HEDIS/Star performance.
  • Maintain a strong knowledge base of HEDIS/STARS and perform related duties as assigned.
Requirements:
  • High School diploma / GED
  • Must be 18 years of age or older
  • 2+ years of healthcare experience in provider and patient-facing interactions
  • 1+ years of quality chart review and abstraction experience, with the ability to analyze data and provide recommendations for improvement.
  • Proficiency in Microsoft Office applications, including Outlook, Word, PowerPoint, and Excel spreadsheets.
  • Up to 75% local travel and a valid NM Driver's License
  • Ability to work various 8-hour shift schedules during our normal business hours.
Preferred Qualifications:
  • 1+ years of experience in HEDIS/STARS
  • ICD 10 and CPT coding experience
  • Experience working in a physician, provider, and/or medical office
  • EMR and HEDIS knowledge and experience

We offer comprehensive benefits, career development opportunities, and a culture guided by diversity and inclusion. If you're passionate about improving health outcomes and working collaboratively with our team, we encourage you to apply.

At Optum, we're committed to creating a workplace that's inclusive and respectful. We're 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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