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HEDIS Clinical Quality Specialist, Supplemental Data - Telecommute

UnitedHealth Group

Denver, CO
Job Code:
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Job Details

HEDIS Clinical Quality Specialist, Supplemental Data - Telecommute(Job Number:729591)

Talk about meaningful work. Talk about an important role. Let's talk about your next career move. Delivering quality care starts with ensuring our processes and documentation standards are being met and kept at the highest level possible. This means working behind the scenes ensuring a member-centric approach to care. As a Senior Quality Analyst you will monitor and support health plan quality improvement initiatives with particular emphasis on compliance with state and federal regulatory and accreditation requirements. You'll act as a voice for our members, guiding the development of comprehensive care plans that will help others live healthier lives. Here's your opportunity to discover 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.  Clinical data quality 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 Associate Director, Supplemental Data Operations. In this position, you will work with the HEDIS Operations staff to assist with the HEDIS data collection cycle.


The purposes of this role include, but are not limited to:Supplemental data management efforts, Medical record review, abstraction and data entry for HEDIS and HEDIS-like measures, and Over-read of medical records.


The candidate must be technically savvy and must be able to work without distraction. This is a high production environment, and candidates must adhere to measured productivity requirements.


HEDIS supplemental data management is inherently complex given the NCQA guidelines which must be adhered to. The complexity of our organization adds to the complications. The candidate must have a combination of strong time management skills and project management skills, as well as strong communication and organizational skills. This candidate must be highly achievement oriented to execute on operational goals.


***This position can be located at any UnitedHealth Group location in the U.S.***


Primary Responsibilities:

  • Performs provider / practitioner medical record reviews, abstraction and data entry for HEDIS and HEDIS-like measures as part of HEDIS Operations
  • Reviews assigned medical records in order to abstract clinical data elements for HEDIS reporting, e.g., results of laboratory tests, verification of hypertension and the most recent blood pressure reading, prenatal and postpartum care services
  • Integrates data collected from a variety of electronic and paper sources
  • Identifies findings supported by documentation guidelines with high level of accuracy
  • Documents abstraction findings in HEDIS database tool
  • Documents over-read findings in HEDIS database tool
  • Maintains HIPAA standards and confidentiality of protected health information; reports critical incidents immediately
  • Communicates identification of pursuit leads for additional medical records, if needed, to other members of the team
  • Attends conference calls as necessary to provide information relating  to clinical reviews and compliance
  • Successfully completes HEDIS technical specification training and testing
  • Successfully completes HEDIS software training and uses software correctly
  • Is responsible for meeting daily over-read and abstraction production goal
  • Is responsible for meeting and maintaining quality requirement of 95% abstraction accuracy
  • Performs other duties as assigned
  • Works with limited guidance
  • Translates concepts into practice
  • Uphold UnitedHealthcare Cultural Values

Job Quality Management
Primary Location US-CO-Denver
Other Location US-Minnesota
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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