UnitedHealth Group Associate Director, QSD Clinical Review - Telecommute in Boston, Massachusetts

UnitedHealthcare’s Quality Solutions Delivery (QSD) is an integrated team serving all UnitedHealthcare businesses, focused on delivering operational efficiencies for centralized activities. Document Management is integral to the success of HEDIS® hybrid data collection and support supplemental data efforts as well.

QSD combines talented individuals from many areas of quality. Our goal is extraordinary performance that exceeds the expectations of the constituents, customers and members we serve.

This position reports to the Director, QSD Clinical Review®.

This position can be located at any UnitedHealth Group location in the U.S. Candidates must be willing to work CST / EST work hours.

Primary Responsibilities:

  • Contribute to annual project plan to achieve all HEDIS® Clinical Review tasks and objectives

  • Observe and comply with policies and procedures for:

  • Abstraction (medical chart interpretation and data entry)

  • Inter-Rater Reliability (IRR)

  • Vendor Inter-Rater Reliability (VIRR)

  • Medical Record Review Validation (MRRV)

  • Conduct interviews and hire appropriate resources to satisfy all operational objectives including seasonal staffing

  • Manage assigned team and scope

  • Clinical Review Group 1

  • Team member responsible for this group will also be responsible for Data Release Governance, serving as liaison to vendors for VIRR results and supporting Medisys staffing agency relationship

  • Clinical Review Group 2

  • Clinical Review Group 3

  • Clinical Review Group 4

  • Partner with training team to ensure engagement and participation in training programs for all clinical review staff

  • Maintain expertise on all measures within HEDIS®/Stars and HEDIS®-like performance guarantee or custom state measure requirements in QSD scope

  • Lead domestic resources and facilitate engagements /provide oversight for international resources for clinical operations

  • Be fully versed and trained and ensure team trained on all HEDIS® Software, Onbase & HTA

  • Conduct abstraction activities for charts collected internally and in scope for Clinical Review Group

  • Participate and ensure staff engagement in all User Acceptance Testing (UAT) pertaining to HEDIS® Software, Onbase and HTA

  • Engage with international resource programs, Optum Global Solutions, to resource team where appropriate

  • Oversee staff engaged in all activities above

  • Design and facilitate implementation development programs for all permanent direct & indirect reports

  • Uphold UnitedHealthcare Cultural Values

For Clinical Review Group assignment:

  • Conduct Inter-Rater Reliability assessments on all internal abstraction staff as well as vendor partner clinical abstraction efforts

  • Identify and document trends with any abstraction concerns

  • Engage directly with staff to resolve individual errors within UHC or engage with vendor liaisons to resolve errors identified with vendor partners

  • Conduct Medical Record Review Validation

  • Identify and document trends

  • Engage with vendor liaisons to resolve errors identified with vendor partners

  • Engage with Roadmap/Auditor team on any issues that require clarification

  • Ensure errors identified are taken to resolution

  • Ensure all charts are pulled and documented to support final MRRV audits

  • Develop and support any corrective action plans, if required

  • Conduct analysis of retrospective operations and engage teams to identify improvements

  • Implement process improvements annually

  • Conduct year round abstraction and IRR activities for all charts collected internally (within volume scope)

Required Qualifications:

  • Minimum 4 year degree

  • Clinical and/or Health Education experience

  • 2+ years of managerial/supervisory experience with direct reports

  • Minimum 4 year Healthcare/Health Plan experience

  • Experience with HEDIS® measures

  • Minimum of 1 year proven success managing, implementing or auditing quality programs

  • Demonstrated ability to assist with focusing activities toward a strategic direction and achieve targets

  • Strong project management skills

  • Excellent team development skills

  • Strong proficiency with Microsoft Office applications, including: Word, Excel and PowerPoint

Preferred Qualifications:

  • RN or LPN

  • Experience working with international resources for clinical process operations.

  • Basic statistical knowledge and application of continuous quality improvement concepts, such as Six Sigma or PDCA

Soft Skills:

  • Strong interpersonal skills

  • Excellent time management and prioritization skills

  • Excellent written and verbal communications skills

Careers with UnitedHealthcare . Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can 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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