Manager of Quality Operations, RN – Remote in Central or Eastern Time Zone

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. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. 

 

The Manager of Quality Operations is responsible for management of Optum Clinical Excellence Supplemental Data Operations staff.  This role is responsible for coordinating and implementing the HEDIS and STAR’s data collection and abstraction activities, developing the Supplemental Data Entry and Primary Source Verification processes and assisting with the coordination of HEDIS® and STARs data gathering process within EMR systems, DataRAP, Cozeva, and additional applications as needed.  This role performs quality assurance checks on staff, determining best practices and relaying necessary process improvement.  The Manager of Quality Operations provides direction and support to various corporate interdepartmental teams and Optum markets in the implementation of strategies for closing care gaps.  This role manages remote supplemental data entry and over read teams, requiring collaboration with Optum Care Delivery Organizations, offshore vendors and various functional areas of the health IT delivery system to achieve the goals and objectives of the Clinical Excellence Quality. 

 

If you are located in Central or Eastern Time Zone, you will have the flexibility to work remotely* as you take on some tough challenges.

 

Primary Responsibilities: 

• Provide leadership and support for the Optum Clinical Excellence Supplemental Data Operations staff
• Provide leadership and support in establishing the Quality Excellence Initiatives at the corporate level
• Collaborate with physicians and support staff to execute the implementation of the clinical quality initiatives as defined by the enterprise
• Analyze data for possible discrepancies and deficits, document findings and implement mitigation best practices
• Over read the data entry of non-standard supplemental data obtained from medical record reviews
• Manage chart chase process
• Support and improve communications between market and corporate departments
• Maintain education/knowledge base of HEDIS®/STARs standards and guidelines
• Provide expertise to IT and the corporate training department on STAR/HEDIS® measures and on the tools that support the collection of STAR/HEDIS® data
• Conduct training on HEDIS/STAR measures, HEDIS/STAR data collection software and data collection strategies
• Collaborate with internal market teams and external vendors to resolve data transmission issues.  
• Analyze and trend HEDIS/STAR rates, identify barriers to improvement of rates based on HEDIS supplemental submission requirements via enterprise data systems and team work processes Provide process 
  improvement strategies to enterprise leadership for improving data capture and outcomes
• Update QI Project templates, staff training materials, and Work Plans with assigned responsibilities
• Assist Director with staffing and cost model
• Perform all other related duties as assigned

 

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: 

•  Registered Nurse with active license within residing state
•  3+ years of supervisory or management experience
•  4+ years of HEDIS® abstraction, over read, and / or PSV experience
•  4+ years of healthcare experience to include experience in a managed care setting
•  3+ years of experience with data analysis / quality chart reviews
•  2+ years of experience working with healthcare operations teams
•  Experience presenting to large teams and creating presentation and educational materials
•  Advanced experience using Microsoft office applications, including databases, word-processing, and excel spreadsheets

 

Preferred Qualifications:

•  BSN degree or related field
•  Certified Professional Coder
•  CPHQ Certification 

 

Physical Requirements and Capabilities: 

• Ability to sit for extended periods of time
• Ability to use fine motor skills to operate office equipment and/or machinery
• Ability to receive and comprehend instructions verbally and/or in writing
• Ability to use logical reasoning for simple and complex problem solving

 

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy 

 

The salary range for this role is $89,800 to $176,700 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.

 

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

 

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.   

 

 

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

 

UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.