Clinical Quality Coordinator

3 days ago


Albuquerque, New Mexico, United States Optum Full time
About the Role

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 resources they need to feel their best.

Key Responsibilities
  • Participate in quality improvement initiatives in assigned territories, working collaboratively with the market team in a matrix relationship.
  • Collect medical records that support HEDIS and Stars activities and quality improvement initiatives.
  • Partner with the Clinical Quality, Network Management, and Risk Education teams to identify trends and potential strategies to support assigned practices.
  • Track and trend barriers and challenges that exist within assigned territories to achieve better outcomes.
  • Navigate multiple documentation systems (EMRs) and obtain medical records to improve quality and HEDIS/Star performance.
  • Maintain education/knowledge base of HEDIS/STARS.
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 review data and provide recommendations for improvement.
  • Experience and proficiency using Microsoft Office applications, including Microsoft Outlook, Microsoft Word, Microsoft PowerPoint, and Microsoft Excel spreadsheets.
  • Up to 75% local travel and valid NM Driver's License.
  • Ability to work any of our 8-hour shift schedules during our normal business hours of 8:00am - 5:00pm.
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.
Physical and Work Environment
  • Ability to lift up to 10 pounds.
  • Ability to push or pull heavy objects.
  • Ability to sit for extended periods of time.
  • Ability to stand for extended periods of time.
  • Ability to use fine motor skills to operate office equipment and/or machinery.
  • Ability to properly drive and operate a vehicle.
  • Ability to receive and comprehend instructions verbally and/or in writing.
  • Ability to use logical reasoning for simple and complex problem solving.


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