Quality Review 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.
ABOUT UCAREAt UCare, we deliver high-quality health coverage and services to help members of all ages maintain and improve their health. It's a big job that takes innovative ideas, strategic partnerships, and a commitment to doing the right thing. Above all, it takes a compassionate team that is dedicated to making a real difference in the lives of our members and our communities. WORKING AT UCAREWorking at UCare is more than just a career; it's a mission. A mission that defines us as professionals, unites us as an organization, and shapes how we interact with our members and each other. Our values of integrity, community, quality, flexibility, and respect permeate every aspect of our organization - from who we are and how we act, to what we do and how we do it. We owe our continued success to our employees who proudly embody our mission and values in everything they do. QUALITY REVIEW SPECIALIST
This position is responsible to perform medical record abstraction and the retrieval of clinical medical records to support the annual Healthcare Effectiveness Data and Information Set (HEDIS) process. This position will build relationships with our clinical provider community to assist with quality improvement initiatives and to build organization knowledge and awareness of best practices that may impact HEDIS data collection.·Schedule and perform on-site and remote medical record reviews at physician offices or using provider remote technology such as EpicCare Link.·Prepare and record chart abstractions into UCare's HEDIS data software tool. ·Assist HEDIS Manager with documents needed for annual HEDIS audit process.·Act as a liaison between Quality Management and Provider Network to help advance and operationalize quality improvement initiatives.·Provide clinical and health systems knowledge and expertise to UCare staff and leadership to help ensure quality improvement efforts are both impactful to the health plan's HEDIS rates, but also meaningful to the clinical provider community.·Collaborate with the HEDIS Manager to recommend ongoing development and improvements to the HEDIS process and data collection methodologies. ·Conduct and Analyze axillary medical record audits on advanced directives and medical record standards. ·Other duties and projects as assigned.
Bachelor's degree in Nursing or equivalent experience; RN with current and restricted Minnesota license.Required ExperienceFive years of clinical/health care related experience. Experience with Medicare and/or Medicaid and/or Commercial or Marketplace benefit programs. Demonstrated experience in completing clear and meaningful written and verbal communication. Proficient PC skills. NCQA HEDIS (Health Effectiveness Data and Information Set) experience and knowledge.
Preferred ExperiencePractical experience in and/or knowledge of NCQA HEDIS process and quality reporting. Experience working in managed care. Database knowledge and development. Claims systems and/or electronic medical records. Clinical documentation and coding knowledge.
THE UCARE DIFFERENCEUCare is proud to be a recognized Star Tribune Top Workplace for the 9th consecutive year. As a part of our collaborative team, you'll experience the rewards that come with helping others and seeing the positive results of your hard work. We value and respect each individual's ideas and contributions, and give you the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, a myriad of volunteer activities, and a number of other rewards. If you're looking for a welcoming environment that celebrates what you have to offer, helps you build on your strengths, and gives you the opportunity to truly make a difference, we invite you to apply. As an Equal Opportunity/Affirmative Action Employer, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.
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.