Per Diem Clinical Quality Analyst (SME) - National Remote

$58,302 - $114,296/Yr

UnitedHealth Group - Phoenix, AZ

Part-time - Entry Level

Remote - Phoenix, AZ

Insurance Carriers and Related Activities

About the position

The Clinical Subject Matter SME within the Risk Quality and Provider Enablement division of Optum Insight provides technical expertise to abstraction and overread teams for IOA, HEDIS® Supplemental and Chart Chase. This part-time position (up to 20 hours/week) focuses on quality audits, coaching, and supporting abstraction processes to improve health outcomes and advance health equity.

Responsibilities

• Participate in Medical Record spot audits
• Serve as a Subject Matter Expert of NCQA's HEDIS® Technical Specifications for all HEDIS® Retrospective, Prospective and Administrative Measures
• Provide leadership and participation on abstraction/overread office hours
• Review and respond to abstraction and overread questions and rebuttals (i.e., Coach Tracker)
• Responsible for reviewing all overread failures in the OQGA tool
• Assist with resolving abstraction logic errors as needed
• Learn, understand and apply HEDIS®/CMS measure knowledge to support functional operation proficiency
• Meet team and departmental productivity expectations while maintaining quality standards
• Observe and comply with policies and procedures for assigned scope
• Perform 1:1 coaching with abstractor/overreader when quality issues are identified
• Provide feedback related to annual system updates for MRR abstraction tool
• Participate in developing/pulling reporting documents for progress and results of abstraction

Requirements

• High School Diploma / GED
• 18 years of age or older
• 2+ years of healthcare experience
• 2+ years of experience reviewing medical records
• 1+ year of HEDIS® experience, performing a wide range of functions with strong focus on medical record review and clinical oversight
• Ability to use Microsoft applications such as Outlook daily
• Ability to complete full training needs during the first week of class
• Ability to work nights and/or weekends during peak seasons as needed
• Ability to work per diem (up to 20 hours/week) from January - April

Nice-to-haves

• Coding certificate from AAPC or AHIMA OR Clinical Certification such as LPN, RN, or CNA
• 2+ years of experience in a health care delivery organization
• Knowledge of Medicaid and/or Medicare programs
• Proficiency in presentation skills to audiences of various sizes
• Knowledgeable of current trends in HEDIS® in managed health care
• Knowledgeable of NCQA, Stars, HEDIS®, HOS and CAHPS requirements
• Familiarity with ICD-9-CM, CPT, DRG, LOINC, HCPCS, TOB, POS, NDC coding

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution