Quality Operations Specialist
Health Care that Starts with You!
Join a truly mission-driven organization! Independent, nonprofit UCare is recognized as one of the Minnesota’s leading health plans. We provide more than 225,000 members across Minnesota and western Wisconsin with the health coverage plans and services they need to maintain and improve their health. The innovative coverage we create makes a difference for Medicare-eligible individuals, individuals and families enrolled in Minnesota Health Care Programs, such as MinnesotaCare and Medical Assistance, and disabled adults with special health care needs. UCare is growing in size, membership, products, geographic coverage, and employees. We’re an organization that’s going places. Be part of a team that cares about you, be part of UCare.
The Quality Operations Specialist will partner with the Performance Lead Specialist to support the HEDIS abstraction program and to oversee the daily management of operational activities as they relate to the HEDIS medical records review/abstraction program supported by other departments and external vendor(s). In conjunction with the HEDIS program team, this person will ensure that the review and abstraction of medical records is completed in compliance with NCQA HEDIS Technical Specifications and NCQA Accreditation requirements. The Quality Operations Specialist will work closely with other departments and vendors identifying key improvement opportunities, developing viable solutions and working collaboratively to implement solutions that drive overall performance excellence.
This position requires project management experience, along with demonstrated experience using process/performance improvement methodologies. Our ideal candidate will have HEDIS (Health Effectiveness Data and Information Set) experience and knowledge, along with Quality Assurance/Improvement knowledge. Experience performing medical chart reviews, database knowledge and development, claims systems and/or electronic medical records, and coding knowledge such as CPT, HCPCS, ICD-9/10, DRG and revenue codes is highly preferred.
Bachelor's Degree in Business Administration, Health Care, Public Health, Information Systems, Social Sciences or other related field is required. Lean certification highly desirable.
At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve. EOE/AA
Enter a highly collaborative environment where people are truly engaged, and feedback is valued. You’ll enjoy a competitive salary and benefits, as well as a host of other perks, including a nationally recognized wellness program, and a bright, open, award-winning office space in Northeast Minneapolis—just minutes from major freeways and retail centers.
At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.