Clinical Quality Specialist

**Requisition number:** 2375517 **Job category:** Medical & Clinical Operations **Explore opportunities with WellMed,** part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will be part of a team who shares your passion for helping people achieve improved health outcomes. Explore rewarding opportunities for physicians, clinical staff and non-patient-facing roles. Join us and discover the meaning behind **Caring. Connecting. Growing together.** This position is responsible for the coordination of HEDIS and STARs data gathering process. This evaluates the quality and completeness of clinical documentation processes by performing quality medical record reviews, assisting in the improvement of the clinical documentation process, identifying trends, maintaining accurate records of review activities, ensures all data submitted to the health plan meets the HEDIS/Star technical specifications for medical records while maintaining a small group membership. **Primary Responsibilities:** + Assisting in the review of medical records to highlight Star/HEDIS opportunities for the medical staff + Review medical records for data collection, data entry, and quality monitoring including health plan/WellMed form submission and chart collection activities that close gaps in care + Partner with the leadership team, to support data mining with a focus on group, large practice, targeted and special projects + Communicate scheduling challenges or trends that may negatively impact quality outcomes + Track and trend barriers/challenges that exist at their assigned groups so that better outcomes can be achieved including access to appointments, lack of follow up on referrals, or inconsistent billing practices + Activities may include data collection, data entry, quality monitoring, health plan/WellMed form submission and chart collection activities + Assists with local IRR audits + Navigate multiple documentation systems and obtain medical record sections supportive of HEDIS/Star measures + Support chart chase process by requesting records from provider's offices as needed + Maintains education/knowledge base of HEDIS/STARs + Performs all other related duties as assigned You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + High School diploma or GED + 3+ years of healthcare experience to include experience in a managed care setting + 3+ years of experience with data analysis/quality chart reviews Must be able to review data and provide recommendations for improvement + Experienced using Microsoft office applications, including databases, word-processing, and excel spreadsheets + This position requires Tuberculosis screening as well as proof of immunity to Measles, Mumps, Rubella, Varicella, Tetanus, Diphtheria, and Pertussis through lab confirmation of immunity, documented evidence of vaccination, or a doctor's diagnosis of disease **Preferred Qualifications:** + 2+ years of experience working with HEDIS/STAR measures + 2+ years of college, in pursuance of a bachelor's or associate degree + Experience or participation with similar regulatory reporting + ICD 10/11 and CPT coding experience + Experience working in a physician, provider, and/or medical office + EMR and HEDIS knowledge and experience Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $20.00 to $36.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable. _At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._ _UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment._