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Medicare Stars Senior Data Analyst - Remote


Data Analyst


Eden Prairie, Minnesota, United States

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Come make an impact on the communities we serve as we help advance health equity on a global scale. Here, you will find talented peers, comprehensive benefits, a culture guided by diversity and inclusion, career growth opportunities and your life's best work.(sm)

In the Medicare Stars Senior Data Analyst role, you will be accountable for improvement on Medicare Stars Ratings including the HEDIS and Pharmacy related measures. This will involve working on measure gap closures, coding accuracy, data validations, facilitating effective reporting, consulting between internal and external teams, proactively identifying performance improvement opportunities, and being a subject matter expert on all things Star Ratings through the use of data analytics, technology, reference material, following specifications, and providing operational support.

You will have responsibility for creating relationships with key cross-functional stakeholders to ensure awareness of and reliance on Star Ratings subject matter expertise for validation of existing and proposed data used for Stars HEDIS and Pharmacy measures. Work across the business areas to ensure alignment of data and reporting for internal and external clients. Build relationships and work effectively in a matrixed environment with internal and external business partners. Example: UnitedHealthcare Star Analytics, HEDIS and Pharmacy teams, Operations, Product, Optum IT, Market leadership, Finance, Compliance, Network, and external clients.

The Medicare Stars Senior Data Analyst position will research, analyze and report various aspects of Medicare Star measures focusing on HEDIS and Part D measures to ensure the highest level of data quality to achieve 4 Star or better annual ratings. The position will work with internal and external business partners, as well as technology constituents to understand and validate data and processes. Working with Optum IT and Tech partners you will learn and understand back-end data that go into the star measures, document and translate business requirements, help to pull and set up data for reporting out on progress.

Use technical skills to manipulate data using SQL, SAS, Tableau, Excel, Teradata, or other tools to provide actionable information to internal customers in support of their business goals by business & product line. Includes ownership of clinical quality reports: design, development, programming, maintaining and publishing reports to support operational & strategic business opportunities. Requires consulting with users to evaluate business & reporting requirements, identify operating procedures, evaluate existing or proposed systems, prepare detailed specifications from which reporting programs will be written and create reporting programs as needed. Help build reporting and data visualizations to create data driven analytics that drive strategies and measure interventions to ensure our Special Needs Plans achieve 4+ Star goals.

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

Primary Responsibilities:

  • Learn, research, and analyze the data and processes associated with quality measure data from existing EMR platforms which feed the supplemental data process
  • Engagement in design, development, production, maintenance and archiving of reporting and data needs to support the Stars and Quality Programs
  • Work with others, including internal and external business, to interpret, develop & document report specifications, provide data-driven direction & guidance for Stars and clinical quality improvement
  • Understand HEDIS, PQA and NCQA technical specifications to apply to each measure’s criteria
  • Collaborate with internal cross functional teams to assist in the development and review of business and technical requirements
  • Evaluate data and reports for accuracy and validity; ensure that reporting meets customer requirements / regulations
  • Collaborate with internal analytics teams to understand clinical quality data flows: create alignment on data analytics methodologies used, identify and resolve data issues as they arise, and coordinate projects to implement changes
  • Support analysis of complex data for trending and patterns; recognize significance of findings and identify improvement opportunities; participate in making program and process recommendations
  • Keep a full load and manage multiple projects being able to report out on progress and present analyses and findings to various stakeholders
  • Within the Optum Home & Community division, our focus is on Special Needs Populations for DSNP (Dual Eligible Medicaid and Medicare) as well as Institutional members

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:

  • 3+ years of experience in Health Care Analytics
  • 3+ years of experience with process improvement, workflow, benchmarking and/or evaluation of business processes
  • 2+ years of experience with database tools: SQL, SAS and/or similar data manipulation tools
  • 2+ years of experience with analytics/visualization tools: Power BI, Tableau, or others
  • 1+ years of experience working in HEDIS, Pharmacy or Medicare Star Ratings
  • Knowledge in Medicare Star Rating methodology
  • Proficient with Microsoft software programs (Excel, Visio, PowerPoint, etc.)
  • Proven skilled in communication, both written and verbal
  • Proven solid interpersonal skills and ability to interact collaboratively with internal business partners across multiple departments and business segments
  • Ability to interpret Clinical Quality, HEDIS, and/or Pharmacy measure specifications
  • Proven ability to work in a fast paced, complex organization managing multiple projects

Preferred Qualifications:

  • Master's degree in related fields
  • 5+ years of experience in Health Care, Understanding of Medicare Advantage
  • 3+ years of experience working in Stars, HEDIS, and/or Pharmacy at a large national plan
  • Experience and expert level knowledge in HEDIS or Pharmacy operations, with extensive knowledge of specifications, reporting methodology, Medical Record Review operations, supplemental data integration, and HEDIS or Pharmacy reporting requirement
  • Proven solid skills in developing and presenting materials to varying levels of leadership

Careers with Optum. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges.

California, Colorado, Connecticut, Nevada, New York City, or Washington Residents Only: The salary range for California, Colorado, Connecticut, Nevada, New York City, or Washington residents is $85,000 to $167,300. 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 employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

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.

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.