[Hiring] Clinical Quality LPN @UnitedHealth Group

Role Description

The Clinical Quality LPN is responsible for Primary Source Verification and Supplemental Data Entry. They assist with the coordination of HEDIS® and STARs data gathering within Pathway, Ubiquity, XLCare, eHouseCalls, and other applications as needed. This role evaluates the quality and completeness of clinical documentation by performing quality medical record reviews, assisting in the improvement of the clinical documentation process, maintaining accurate records of review activities, and ensuring all data submitted to the health plan meets the HEDIS/Star technical specifications for medical records. This role supports end of year final push activities, as well as hybrid chart chase processes.

You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.

Schedule:

• Monday - Friday, 8:00 a.m. - 5:00 p.m. in your time zone

Primary Responsibilities:

• Review and abstract medical record data into appropriate application(s)
• Support chart chase processes by requesting/obtaining records as needed
• Primary source verify abstracted medical record data
• Analyze chart data, evaluate for possible data integrity and/or data deficits and document findings
• Provide education and feedback to abstractors
• Navigate multiple documentation systems and obtain medical record sections supportive of HEDIS/Star measures
• Support member outreach campaigns within the H&C organization, as needed
• Maintain education/knowledgebase of HEDIS®/STARs standards and guidelines
• Assist team with re-training
• Perform all other related duties as assigned

Qualifications

• Licensed Professional/Vocational Nurse
• 3+ years of experience with data analysis/quality chart reviews. Must be able to review data and provide recommendations for improvement
• 2+ years of HEDIS/STAR experience or participation with similar regulatory reporting
• Proven excellent communication practices, both oral and written
• Experience using Microsoft office applications, including databases, word-processing, and Excel spreadsheets

Requirements

• Associate degree
• Undergraduate degree or equivalent experience
• Certified Professional Coder
• Training experience
• Ability to be flexible in a continuously changing environment

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution (all benefits are subject to eligibility requirements)