Experienced Per Diem Clinical Quality Analyst - Subject Matter Expert (SME) in HEDIS and Healthcare Quality Analytics - National Remote Opportunity

Transform Healthcare Quality with Optum, a UnitedHealth Group Company

At Optum, a global leader in healthcare services and innovation, we're on a mission to help people live healthier lives and make the health system work better for everyone. As part of UnitedHealth Group, we're committed to advancing health equity on a global scale. Our work is driven by a culture of diversity, inclusion, and a passion for improving health outcomes. If you're a seasoned Clinical Quality Analyst with deep expertise in HEDIS and healthcare quality analytics, we invite you to join our team as a Per Diem Clinical Quality Analyst - SME and contribute to our meaningful work.

About the Role

This is a part-time, per diem opportunity (up to 20 hours/week) during peak season (January - April) that requires a strong and diverse skillset in relevant areas to drive success. As a Clinical Quality Analyst - SME within our Risk Quality and Provider Enablement division, you'll provide technical expertise to abstraction and overread teams for IOA, HEDIS Supplemental, and Chart Chase. Your expertise will directly impact the quality of care and health outcomes by ensuring accurate and compliant medical record review and data analysis.

Key Responsibilities

• Participate in Medical Record spot audits to ensure quality and compliance.
• 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, reviewing and responding to abstraction and overread questions and rebuttals.
• Review all overread fails in the OQGA tool and assist with resolving abstraction logic errors as needed.
• Apply HEDIS/ CMS measure knowledge to support functional operation proficiency at a market or reporting population level.
• Work in a self-directive manner, applying critical thinking and problem-solving skills by referencing available Technical Specifications, Business Process Documentation, Job Aids, and other tools.
• Meet team and departmental productivity expectations while maintaining quality standards.
• Perform 1:1 coaching with abstractor/overreader when quality issues are identified.
• Participate in developing and pulling reporting documents for progress and results of abstraction.

Essential Qualifications

• High School Diploma / GED or higher.
• Must be 18 years of age or older.
• 2+ years of healthcare experience.
• 2+ years of experience reviewing medical records.
• 2+ years of HEDIS work experience, performing a wide range of functions with a strong focus on medical record review and clinical oversight.
• Ability to complete full training needs during the first week of class.
• Proficiency in Microsoft applications such as Outlook.
• Ability to work up to 20 hours per week during peak season (January - April).

Preferred Qualifications

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

What We Offer

As a part of UnitedHealth Group, you'll enjoy a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution (all benefits are subject to eligibility requirements). Our culture is guided by diversity and inclusion, and we offer career development opportunities to help you grow professionally.

Compensation and Benefits

The hourly range for this role is $28.03 to $54.95 per hour, based on factors such as local labor markets, education, work experience, and certifications. UnitedHealth Group complies with all minimum wage laws as applicable.

Telecommuting Requirements

• Ability to keep all company-sensitive documents secure.
• Dedicated work area established that is separated from other living areas and provides information privacy.
• Must live in a location that can receive a UnitedHealth Group-approved high-speed internet connection or leverage an existing high-speed internet service.

Join Our Team!

This is a fantastic opportunity to grow your career in a dynamic and purpose-driven organization. If you have the skills and passion we're looking for, please submit your application today. At UnitedHealth Group, we're committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes. We're 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.

Don't miss this chance to make a meaningful impact in healthcare quality and analytics. Apply now to join our team as a Per Diem Clinical Quality Analyst - SME and contribute to our mission to help people live healthier lives and make the health system work better for everyone.

Apply Now