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Quality Improvement Specialist (Bilingual preferred) - La Palma, CA

Company: UnitedHealth Group
Location: Cerritos
Posted on: March 15, 2020

Job Description:

Position Description
We'll put you in the driver's seat on vital projects that have strategic importance to our mission of helping people lead healthier lives. Yes, we share a mission that inspires. We need your organizational talents and business discipline to help fuel ours. It's the opportunity to do your life's best work.(sm)

Responsible for Clinical Performance Improvement related activities, including but not limited to, P4P/AMP, HEDIS, and Medicare STARS quality improvement programs. Develops and implements new strategies to improve all scores.

Primary Responsibilities:
Reconcile gaps in care reports from health plans to AppleCare gaps in care reports Prepare & send supplemental data files to the health plans Prepare reports regarding performance of various initiatives Prepare and maintain quality calendar of events Collaborate with NM & PCP offices on quality improvement projects Data entry and approval of manual entries (PSV) Outreach provider offices regarding gap reports and medical records Focus on small denominator measures such as OMW and ART Work with external vendors to ensure members receive services as needed Analyze/prepare member and provider chase lists for quality gaps Validate records selected for P4P/AMP audit Validate measures in charts for health plan audits Manage outbound member reminder call initiatives for quality measures Mentors others Prepare and update Quality Toolkits Develop & implement 5 STAR office programs Testing and validation of quality systems and reports Work with internal departments to resolve provider/data issues Field incoming calls and provide excellent customer service to providers and members Occasional travel to provider offices
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.

Required Qualifications:
High school education or equivalent experience Two (2) or more years in the following areas: Managed care Quality improvement experience Customer Service Data Entry Intermediate to advanced proficiency in Excel, Outlook and Word. Valid California Driver's License and proof of automobile insurance

Preferred Qualifications:
Bilingual English/Spanish/Chinese/Vietnamese is highly preferred Experience and knowledge of NCQA, IHA-P4P/AMP, and CMS-STAR measures. Mentors others Analysis and reconciliation Experience in Medicaid Quality Initiatives Medical Assistant (MA) certification

Soft Skills Preferred:
Applies knowledge/skills to complex activities Work does not usually require established procedures. Works independently Demonstrates a depth and breadth of knowledge/skills in own area and is often able to apply these outside of own function. Often acts as a technical resource to others in own function. Anticipates customer needs and proactively identifies solutions. Experience solving complex problems on own; proactively identifies new solutions to problems. Ability to plan, prioritize, organize and complete work to meet established objectives.
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

-- 2018 OptumCare. All Rights Reserved.

OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare's support services do not interfere with or control the practice of medicine by the medical

practices or any of their physicians.

AppleCare Medical Group was formed in Lynwood, California in 1996 with the goal of making quality care available locally to the community. Today, AppleCare Medical Group is comprised of hundreds of board-certified private-practice, independent physicians. These physicians provide medical expertise and passion to improving the health of communities in the Southeast area of Los Angeles and Northern Orange County.

Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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 laws

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment

Job Keywords: Managed care, healthcare, data entry, faxing, Medicare, providers, STARS, HEDIS, P4P, Spanish, Bilingual, Excel, Word, Outlook, La Palma, CA, California

PandoLogic.Category: Quality Control, Keywords: Quality Control / Quality Assurance Specialist

Keywords: UnitedHealth Group, Cerritos , Quality Improvement Specialist (Bilingual preferred) - La Palma, CA, Other , Cerritos, California

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