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Associate Director, HEDIS Clinical Review

UnitedHealth Group

Tampa, FL
Job Code:
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Job Details

Associate Director, HEDIS Clinical Review(Job Number:706502)

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm)


UnitedHealthcare’s HEDIS Operations is an integrated team serving all UnitedHealthcare businesses, focused on delivering operational efficiencies for centralized activities.  Document Management is integral to the success of HEDIS hybrid data collection and support supplemental data efforts as well.
HEDIS Operations combines talented individuals from many areas of quality. Our goal is extraordinary performance that exceeds the expectations of the constituents, customers and members we serve.
This position reports to the Director, HEDIS Clinical Review. 
***This position can be located at any UnitedHealth Group location in the U.S.***
Primary Responsibilities:
  • Contribute to annual project plan to achieve all HEDIS Clinical Review tasks and objectives
  • Observe and comply with policies and procedures for:
    • Abstraction (medical chart interpretation and data entry)
    • Inter-Rater Reliability (IRR)
    • Vendor Inter-Rater Reliability (VIRR)
    • Medical Record Review Validation (MRRV)
  • Conduct interviews and hire appropriate resources to satisfy all operational objectives including seasonal staffing
  • Manage assigned team and scope
    • To meet contractual and accreditation goals
      • Team member responsible for this group will also be responsible for Data Release Governance, serving as liaison to vendors for VIRR results and  supporting Medisys staffing agency relationship
  • Partner with training team to ensure engagement and participation in training programs for all clinical review staff
  • Maintain expertise on all measures within HEDIS/Stars and HEDIS-like performance guarantee or custom state measure requirements in HEDIS Operations scope
  • Lead domestic resources and facilitate engagements /provide oversight for international resources for clinical operations
  • Be fully versed and trained and ensure team trained on all HEDIS Software, Onbase & HTA
  • Conduct abstraction activities for charts collected internally and in scope for Clinical Review Group
  • Participate and ensure staff engagement in all User Acceptance Testing (UAT) pertaining to HEDIS Software, Onbase and HTA
  • Engage with international resource programs, Optum Global Solutions, to resource team where appropriate
  • Oversee staff engaged in all activities above
  • Design and facilitate implementation development programs for all permanent direct & indirect reports
  • Uphold UnitedHealthcare Cultural Values
    Conduct Inter-Rater Reliability assessments on all internal abstraction staff as well as vendor partner clinical abstraction efforts
    • Identify and document trends with any abstraction concerns
    • Engage directly with staff to resolve individual errors within UHC or engage with vendor liaisons to resolve errors identified with vendor partners
  • Conduct Medical Record Review Validation
    • Identify and document trends
    • Engage with vendor liaisons to resolve errors identified with vendor partners
    • Engage with Roadmap/Auditor team on any issues that require clarification
    • Ensure errors identified are taken to resolution
  • Ensure all charts are pulled and documented to support final MRRV audits
    • Develop and support any corrective action plans, if required
  • Conduct analysis of retrospective operations and engage teams to identify improvements
  • Implement process improvements annually
  • Conduct year round abstraction and IRR activities for all charts collected internally (within volume scope)

Job Quality Management
Primary Location US-FL-Tampa
Other Location United States
Organization Population Health Management
Schedule Full-time
Number of Openings 1
Apply on the Company Site

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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