Requisition Number: 2267750
Job Category: Nursing
Primary Location: Eden Prairie, MN, US
(Remote considered)
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data, and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits, and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.
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.
You’ll enjoy the flexibility to work remotely * from anywhere within CST OR EST 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
- Provider 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
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.
- Licensed Professional / Vocational Nurse
- 3+ years of experience with data analysis/quality chart reviews. Ability 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
- Excellent communication practices, both oral and written
- 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