Quality Review Specialist

7 days left

Minneapolis, Minnesota
Dec 22, 2022
Feb 14, 2023
Employment Status
Full Time
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 600,000 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.


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.




UCare offers Medicare, Medicaid, Individual and Family health plans - powered by the hardest working people in the industry. Our people powered teams de-complicate, advocate and always go the extra mile to help our members. We serve with integrity, compassion and commitment to do right by members, providers and government partners. Above all, we come to work excited to provide members a path for the best health of their lives.


Working at UCare is more than 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. Employees join UCare and stay because of the opportunity to have a purpose-driven job.

Our strong culture has established UCare as a Star Tribune Top 200 Workplace for 13 consecutive years since the awards program began. It's a culture that embraces innovative ideas, strategic partnerships, and exemplary customer and provider experiences. Working at UCare is being a part of a people powered team dedicated to making a real difference in the lives of our members and communities.


Work Location: Work From Home or Office for Your Day

The health and safety of our employees, members, providers, and our community is our highest priority. Therefore, all new employees are expected to be fully vaccinated against COVID-19 prior to starting at UCare, subject to limited exceptions such as for a sincerely held religious belief or for medical reasons.

Position Description

This position is responsible to perform retrieval of clinical medical records and medical record abstraction to support the annual Healthcare Effectiveness Data and Information Set (HEDIS) process as well as for adhoc quality audits. 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. This position also supports quality intervention strategy, design, implementation and execution for all product lines and multiple HEDIS measures.

• Schedule and perform on-site and remote medical record reviews at physician offices or using provider remote technology such as EpicCare Link.

• Prepare and execute 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 with current unrestricted Minnesota RN license; or Bachelor's degree in a healthcare related field; demonstrated work experience may be considered in lieu of degree.

Required Experience

Five 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 Experience

Practical 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 difference is our people power - employees actively working on the behalf of our members to get them access to the health care they need. We value and respect each individual's ideas and contributions, and provide the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, and a myriad of volunteer activities. If you're looking for an inclusive environment that celebrates your people power, 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.

JOB POST DATE: 12/21/2022

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