1+ months

HEDIS Clinical Quality Analyst - Grand Junction, Denver, CO - 892138

Denver, CO 80204
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  • Job Code
    892138

Doing the right thing is a way of life at Rocky Mountain Health Plans (RMHP). As part of the UnitedHealthcare family of plans, RMHP provides innovative health insurance coverage and personalized attention to individuals of all ages and business of all sizes throughout Western and rural Colorado. RMHP is continually striving to improve the health and wellness of our Members and partners in the state where we live, work, and play - because we're Colorado, too.


You push yourself to reach higher and go further. Because for you, it's all about ensuring a positive outcome for patients. In this role, you'll work in the field and coordinate the long-term care needs for patients in the local community. And at every turn, you'll have the support of an elite and dynamic team. Join UnitedHealth Group and our family of businesses and you will use your diverse knowledge and experience to make health care work better for our patients.


Under the direction of the QI Department Management, utilizes technical and professional experience to implement and support the annual HEDIS project. HEDIS measure implementation and. During HEDIS medical record collection utilizes technical expertise to function as the project lead for HEDIS medical record pursuit.


Primary Responsibilities:

  • Assist the Manager and Director in the planning and evaluation of the annual HEDIS medical record project
  • Respect confidentiality and maintain confidences as described in the UHG Employee Handbook and acknowledged through signature by all employees. The ability to maintain confidentiality is a critical and essential component of this position
  • Prepare training materials for the annual HEDIS medical record abstraction training class and assist the HEDIS project manager to train the medical record abstractors
  • Assist the HEDIS project manager prepare for the annual HEDIS site visit and the medical record review validation audit compiling and preparing documentation for these audits
  • Develop a strategy to prioritize the pursuit of medical records for HEDIS data collection of hybrid measurements
  • Implement the medical record prioritization plan in collaboration with the Manager
  • Evaluate the effectiveness of the HEDIS medical record prioritization plan and make recommendations to the Manager for changes to the process to enhance the effectiveness and efficiency of the prioritization process
  • Identify and research quality measurements that can be improved through member and provider interventions
  • Review claims data to identify opportunities to work with internal staff and provider offices to improve appropriate coding for services
  • Assist in all aspects of medical record retrieval, abstraction, and auditing as assigned by Manager
  • Represent QI Department effectively and actively in all internal or external meetings as requested by Management
  • Responsible for working with Manager, prioritizing analytical assessment and reporting needs related to quality assurance, provider intervention activities and any other data needs
  • Special tasks and projects as assigned by Manager and Director

This position requires travel. Requires independent, reliable, flexible, and on-demand, transportation at the incumbent's expense for travel between various locations and timely arrival and departure from various locations. If the employee chooses to satisfy this requirement by driving a vehicle, the employee must meet the requirements for Colorado licensure and company requirements for liability insurance coverage.


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:

  • Bachelor's degree in business, health care, related field, or the combination of education and experience that would enable performance of the full scope of the position
  • 3 years of related progressive experience with HEDIS data collection
  • Experience with Electronic Medical Records and HEDIS data files
  • Experienced in quality improvement principles, including research and measurement
  • Experience with Word, Excel and PowerPoint
  • Demonstrated skills in technical/professional writing, including creating reports
  • If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders


Preferred Qualifications:

  • Previous experience with QI in a managed care setting
  • Comfortable and effective in interacting with members and providers
  • Work effectively as a team member with peers, company leadership, and Medical Directors
  • Presentation and Project Management skills


Doing the right thing is a way of life at Rocky Mountain Health Plans (RMHP). For more than 225,000 members of our unique, physician-founded health care organization, we provide innovative health insurance coverage and personalized attention to individuals of all ages and business of all sizes throughout Western and rural Colorado. As a part of Optum, the fastest growing part of the UnitedHealth Group family of businesses, we've enhanced our offerings through sophisticated tools and technologies, superior customer service and a commitment to striving to improve the health and wellness of our Members and partners in the state where we live, work, and play - because we're Colorado, too. From a career perspective you couldn't do better. We're all about quality and making a difference. And can make our opportunities your opportunity to do your life's best work.(sm)


Diversity creates a healthier atmosphere: UnitedHealth Group is 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.


UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.


Job Keywords: HEDIS, Quality Improvement, Managed Care, Healthcare, EMR, Grand Junction, Denver, Colorado

Posted: 2020-11-25 Expires: 2021-01-24

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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HEDIS Clinical Quality Analyst - Grand Junction, Denver, CO - 892138

UnitedHealth Group
Denver, CO 80204

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