The Director of Quality HEDIS Submission Data Validation is responsible for leading, coordinating, validating, and executing on the HEDIS Submission by enterprise. This includes data validation of sources, ensuring that all documentation required is completed, internal and payor audits, IT collaboration, and any workflows that need to be created to support the HEDIS submission.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
- Facilitates, integrates, and / or coordinates the implementation and evaluation of identified quality improvement / HEDIS / STAR activities
- Develop, execute and document a STAR/HEDIS chart chase submission process with multiple payers
- Identifies and follows through on opportunities to improve completeness as well as accuracy of the STAR / HEDIS data submission to include development of STAR reconciliation process with multiple payers.
- Collaboration includes but is not limited to the National Director CDQI team, Optum Insight, Optum Data Management and United Health Group on quality activities
- Participates in requested evaluations and audits for UHC and other health plans
- Maintain QI program documents, reports, committee minutes, and follow all internal privacy and confidentiality policies and procedures
- Develop and maintain various policy and procedures for Quality Data Support including reporting intake and requirement collections, User Acceptance Testing, and Project Tracking Process
- Collaborate with WellMed and Optum Data Management leadership to submit accurate and complete HEDIS / Star data during annual submission
- Streamline and update operational, functional, and performance based reporting
- Develop and support an ongoing data audit progress to ensure data integrity
- Ensure integration and refinement of reporting across the enterprise
- Standardize processes that ensure a provider feedback loop for reporting and analytics
- Ensure implementation of standardized reporting across the enterprise
- Oversee and evolve actionable reporting tools and capabilities for deployment across business owners, providers and clinical teams
- Support Analysis on medical, cost, clinical and diagnosis data to improve outcomes
- Validate accuracy of data
- Oversees vendor relationships, negotiations, and ensure contractual and performance standards are met
- Collaborates with IT in developing technical solutions that will provide the provider and market leaders with decision making material. Drives efficient data collection, data management, and data reconciliation related to quality processing.
- Oversees lab data consumed at the Enterprise level utilized for Quality initiatives
- Utilize analytics to further clinical and business goals
- Communicate findings, and work with business owners to implement processes based on results
- Educate internal and external customers, business owners, and stake holders on findings
- Identify / engage / educate appropriate decision makers / stakeholders to gain acceptance for recommended process / system improvements
- Manage / support / provide subject matter expertise to internal project initiatives (e.g., risk management, process improvement, cost savings)
- Performs 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
- Bachelor’s Degree in Health Care Administration, Business Administration or a related field (4 additional years of comparable work experience beyond the required years of experience may be substituted in lieu of a bachelor’s degree)
- 5+ years of experience in Medicare Quality to include CMS STAR / HEDIS submission requirements and regulations
- 5+ years of data analytics experience utilizing Microsoft SQL Server
- Experience with Microsoft Office applications to include Word, Excel, Visio, PowerPoint and Outlook
- 5+ years of product / project management experience successfully conceptualizing an initiative, developing a plan, working cross functionally, and executing the plan through implementation
- 5+ years of experience interacting with and presenting to executive management
- 5+ years of experience managing staff
Preferred Qualifications
- Masters in Health Administration, Finance, Public Health or Business Administration.
- Certification and / or training in a nationally recognized Change Management Methodology
- Advanced understanding of concepts and practices of Six Sigma / PMP
Careers with Optum. Here’s the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world’s large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life’s best work.(sm)
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy
Diversity creates a healthier atmosphere: 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.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
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