Clinical Quality LPN Remote EST or CST

Company: UnitedHealth Group
Location: San Jose
Posted on: September 14, 2023

Job Description:

For those who want to invent the future of health care, -here's -your opportunity. -We're -going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing -your life's best -work.(sm) -

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 Cozeva, DataRAP 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, ensuring all data submitted to the health plan meets the HEDIS -/Star technical specifications for medical records.

If you are located in -EST or CST, you will have the flexibility to work remotely* as you take on some tough challenges -

Primary Responsibilities:

• 
  
• Review and abstract medical record data into appropriate application(s)
  
• 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 chart chase processes by requesting records from provider offices as needed
  
• Maintain education/knowledgebase of HEDIS -/STARs standards and guidelines
  
• Assist team with re-training
  
• Perform all other related duties as assigned
  
• Position location is CST or EST -
  
• Position location is CST or EST -
  
• 
  
  
  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:
  
  • 
    
  • 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
    
  • Experience using Microsoft office applications, including databases, word-processing, and Excel - spreadsheets
    
    
    Preferred Qualifications:
    
    • 
      
    • Associate degree
      
    • Undergraduate degree or equivalent experience
      
    • Certified Professional Coder
      
    • Training experience
      
    • Demonstrated ability to be flexible in a continuously changing environment
      
    • Proven excellent communication practices, both oral and written
      
      
      Physical & Mental Requirements:
      
      • 
        
      • Ability to lift up to 25 pounds
        
      • 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
        
        
        Careers at OptumCare. -We're on a mission to change the face of health care. As the largest health and wellness business in the US, we help 58 million people navigate the health care system, finance their health care needs and achieve their health and well-being goals. Fortunately, we have a team of the best and brightest minds on the planet to make it happen. Together we're creating the most innovative ideas and comprehensive strategies to help heal the health care system and create a brighter future for us all. Join us and learn why there is no better place to do -your life's best work.(sm) -
        
        OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare's support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians. -
        
        Connecticut, New Jersey, New York, or Rhode Island Residents Only: -The hourly range for Connecticut, New Jersey, New York, or Rhode Island residents is $18.80 to $36.78. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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. -
        
        *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
        
        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. - -
        
        
        Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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. -
        
        OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Keywords: UnitedHealth Group, San Jose , Clinical Quality LPN Remote EST or CST, Healthcare , San Jose, California