Per Diem Clinical Quality Analyst - Subject Matter Expert (SME) in Healthcare Quality Improvement and HEDIS Measures

Join the Team: Per Diem Clinical Quality Analyst - SME at Optum

Optum, a leading global health services company, is seeking a highly skilled and experienced Per Diem Clinical Quality Analyst - Subject Matter Expert (SME) to join our Risk Quality and Provider Enablement division within Optum Insight. As a Clinical Quality Analyst - SME, you will play a critical role in ensuring the quality of healthcare services by providing technical expertise to abstraction and overread teams for various healthcare quality improvement initiatives, including HEDIS (Healthcare Effectiveness Data and Information Set) measures.

About Optum and Our Culture

At Optum, we are dedicated to helping millions of people live healthier lives by delivering care, aided by technology, and connecting people with the care, pharmacy benefits, data, and resources they need to feel their best. Our culture is guided by diversity and inclusion, and we offer comprehensive benefits, career development opportunities, and a dynamic work environment that encourages growth and learning. By joining our team, you will have the opportunity to make a positive impact on the communities we serve and contribute to advancing health equity on a global scale.

Key Responsibilities:

• Participate in medical record spot audits to ensure data accuracy and quality.
• Serve as a Subject Matter Expert (SME) on NCQA's HEDIS Technical Specifications for retrospective, prospective, and administrative measures.
• Provide leadership and participation in abstraction/overread office hours to support teams.
• Review and respond to abstraction and overread questions and rebuttals.
• Perform quality spot audits, individual quality coaching, and tracking/reporting of quality trends.
• Assist with resolving abstraction logic errors and provide support with audit queue.
• Apply HEDIS and CMS measure knowledge to support functional operation proficiency.
• Work independently and apply critical thinking/problem-solving skills.
• Meet team and departmental productivity expectations while maintaining quality standards.
• Comply with policies and procedures for assigned scope.
• Participate in developing/pulling reporting documents for progress and results of abstraction.

Requirements and Qualifications:

Essential Qualifications:

• High school diploma or GED required.
• 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 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.
• Knowledge 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, and NDC coding.
• Coding certificate from AAPC or AHIMA, or clinical certification such as LPN, RN, or CNA.
• Proficiency in presentation skills.
• Knowledge of Medicaid and/or Medicare programs.

Skills and Competencies:

• Strong analytical and problem-solving skills.
• Excellent communication and interpersonal skills.
• Ability to work independently and as part of a team.
• Strong attention to detail and organizational skills.
• Ability to prioritize tasks and manage multiple projects.
• Strong knowledge of HEDIS measures and technical specifications.

Career Growth Opportunities and Learning Benefits:

At Optum, we are committed to the growth and development of our employees. As a Clinical Quality Analyst - SME, you will have opportunities to:

• Develop your skills and expertise in healthcare quality improvement and HEDIS measures.
• Collaborate with a team of experienced professionals in the healthcare industry.
• Contribute to the development of new initiatives and projects.
• Participate in training and development programs to enhance your skills and knowledge.

Work Environment and Company Culture:

As a remote employee, you will have the flexibility to work from anywhere within the U.S. and enjoy a dynamic work environment that encourages growth and learning. Our company culture is guided by:

• Diversity and inclusion.
• Comprehensive benefits and career development opportunities.
• A commitment to advancing health equity on a global scale.

Compensation and Benefits:

We offer a competitive salary and comprehensive benefits package, including:

• A competitive hourly rate of $28.03 to $54.95 per hour, depending on experience and qualifications.
• A comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase and 401k contribution.

How to Apply:

If you are a motivated and experienced healthcare professional looking to make a positive impact on the quality of healthcare services, we encourage you to apply for this exciting opportunity. Please submit your application, including your resume and a cover letter, to [insert contact information]. We look forward to hearing from you!

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.