UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health.
Description
Ingenix is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.
If you get excited about the life transforming potential of bringing health care information to the right place, at the right time, to support crucial decisions, welcome to Ingenix.
We're one of the largest and fastest growing health information companies and the only organization in our industry with the information, technology and consulting expertise to solve the most significant challenges in health and human services.
As a vital member of the UnitedHealth Group family, we serve customers in every segment of the health care field. This includes government agencies, pharmaceutical companies, hospitals and health delivery networks, insurance providers and, of course, the diverse business divisions of UnitedHealth Group.
We seek a highly organized nurse with excellent interpersonal skills to fill this unique Clinical Quality Management Specialist role. This is a key position in our Quality Management Department to support outreach activities and build relationships with our network providers. So, if you want to be part of our winning team...Apply now!
Primary Responsibilities:
- Coordinate and perform onsite medical record reviews at provider offices to determine quality of care
- Lead projects for assigned quality measures including the development, implementation and timely completion of performance improvement initiatives for HEDIS measures as well as Appendix N contract issues and monitoring of regulatory mandates.
- Monitor provider records and assure compliance with service delivery and quality standards at all times
- Educate providers on all aspects of medical record review criteria including HEDIS
- Collaborate with providers to improve rates for quality improvement indicators and standards of care
- Communicate regularly with members, providers and health plan staff
- Perform other duties and responsibilities as assigned
Bring your talent to an industry leader with the information, technology, and consulting expertise to help transform health and human services. No matter what your role, you'll be empowered to ask more questions, develop better solutions and help make the health care system greater than ever.
Qualifications
- A current, unrestricted RN or LPN license in NY
- Minimum of 1 - 2 years managed care nursing experience
- Knowledge of state and NCQA standards and regulations for quality
- Excellent oral and written communication skills
- MS office proficiency
- Ability to travel locally 75%
Assets:
- Medical coding experience preferred
- HEDIS, medical record review experience preferred
- Previous quality management / managed care review experience is a plus.
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
