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Job Details


UnitedHealth Group

HEDIS Supplemental Data and Source Audit SME - Remote

Healthcare

Clinical Data Management

Yearly

No

Minnetonka, Minnesota, United States

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm)

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

  • This role will serve as the Optum Home and Community HEDIS Supplemental Data and source audit SME. The selected candidate will sit on the Optum Home and Community Stars team
  • Will support maximization of clinical model documentation and impact to HEDIS Star performance measures through the maintenance, code rewrite, edit, annual maintenance and audit of supplemental data to align with NCQA requirements
  • Will support new Optum Home and Community EMRs: Ubiquity, Navi, as well as Pathway, eHC, XLCare, and ICUE to maximize HEDIS Star performance tied with Stars revenue, and ensure HEDIS compliance focus within Optum delegated populations and products
  • Requires ability to translate EMR documentation into recommended code mapping rules, coordination of Roadmap audit documentation completion for assigned SDS sources, monitoring monthly prospective PSV audits for sources, and support of annual official PSV for each source
  • Requires knowledge of SDS input mapping fields and HEDIS software, Inovalon experience preferred

This position is full-time. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am – 5:00pm. It may be necessary, given the business need, to work occasional overtime.


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:

  • Undergraduate degree in applicable area of expertise or equivalent experience
  • Experience with HEDIS engine data application and QA for elemental accuracy from sources
  • Knowledge of SDS input mapping fields and HEDIS software
  • Expert in HEDIS Supplemental Data types, integration, and HEDIS data and performance analytics
  • Annual review of revised specifications, vsds, and med lists from NCQA, and implementation of required edits to new and existing sources
  • HEDIS audit expertise including audit documentation coordination or Roadmaps
  • Ability to implement new sources from idea to execution, and onboard new elements with technical teams, ensure file formatting and required elements are included, QA code and SDS files

Preferred Qualifcation:

  • Inovalon experience


Military & Veterans find your next mission: We know your background and experience is different and we like that. UnitedHealth Group values the skills, experience and dedication that serving in the military demands. In fact, many of the values defined in the service mirror what the UnitedHealth Group culture holds true: Integrity, Compassion, Relationships, Innovation and Performance. Whether you are looking to transition from active duty to a civilian career, or are an experienced veteran or spouse, we want to help guide your career journey. Learn more at https://uhg.hr/transitioning-military

Learn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible. https://uhg.hr/vet


To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $97,300 to $176,900. The salary range for Connecticut / Nevada residents is $97,300 to $176,900. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.


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.

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