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Medicare Stars Analytics Consultant - Telecommute

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work. (sm)

The Medicare Stars Analytics Consultant position will audit (research, analyze and report) various aspects of the STARS data flow to ensure the highest level of data quality, data reporting, data analytics, and 4 Star or better annual ratings. The position will work with internal and external businesses, as well as technology constituents to understand and validate data and processes.

Optum Care Services focuses on ISNP, Optum At Home DSNP, HouseCalls, and Post-Acute programs for internal and external clients. The role will support the STARS audit process for Optum Complex Care Management members. This audit process will focus on all CCM Clinical Programs (HouseCalls, ISNP, IE-SNP, DSNP Optum at Home and Post-Acute Care). All aspects of STARS data flow will be in scope from documentation in EMR to Supplemental Data to data submission to prospective / retrospective HEDIS engines.

In the Medicare Stars Analytics Consultant role, you will be accountable for improvement on HEDIS and Stars gap closure, coding accuracy, data validations, transformation documents, facilitating effective reporting, consulting between internal and external teams, proactively identifying performance improvement opportunities, and being a subject matter expert on all things Star Ratings through the use of data analytics, technology, workflow changes, reference material, and clinical support.

You will have responsibility for creating relationships with key cross-functional stakeholders, including clinical, product, Optum IT, reporting, network and operations to ensure awareness of and reliance on Stars Analytics subject matter expertise and validation of existing and proposed data used for Stars and HEDIS measures. Work across the business areas to ensure alignment of data and reporting for internal and external clients. Build relationships and work effectively in a matrixed environment with internal and external business partners. Example: UnitedHealthcare Star Analytics and HEDIS teams, Operations, Product, Optum IT, Market leadership, Finance, Compliance, Network and external clients. With Optum IT to document and translate business requirements. Validates, audits, and evaluates reporting and analytics for clinical quality and Stars reporting.

Use technical skills to manipulate data using SQL, SAS, Tableau, Excel, SSRS, Teradata, or other tools to provide actionable information to internal customers in support of their business goals by product line. Help build reporting and data visualizations to create data driven analytics that drive strategies and measure interventions to ensure plans achieve 4+ Star goals.

You'll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

  • Research and analyze the data and processes associated with quality measure data from existing EMR platform which feed the supplemental data process
  • Understand HEDIS and NCQA technical specifications and apply measure criteria
  • Collaborate with internal analytics teams to understand clinical quality data flows: create alignment on data analytics methodologies used, identify and resolve data issues as they arise, and coordinate projects to implement changes
  • Serve as a key resource to conduct internal data audits, develop analysis and documentation to support findings; present summary to technical teams and leadership
  • Collaborate with internal cross functional teams to assist in the development and review of business and technical requirements
  • Lead and drive work streams to enhance short and long-term clinical quality reporting activities
  • Confident customer-facing approach: can defend analysis, can take input / feedback, and can consultatively say no by providing a range of alternatives, particularly those promoting a standard

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:

  • 3+ years of experience in Health Care Analytics
  • 3+ years of experience with process improvement, workflow, benchmarking and / or evaluation of business processes
  • 2+ years of experience with database tools: SQL, SAS and/or similar data manipulation tools
  • 2+ years of experience with analytics / visualization tools: SSRS and/or Tableau
  • 1+ years of experience working in Medicare Star Ratings
  • Knowledge in MEDICARE Star Rating methodology
  • Ability to interpret HEDI S/ clinical quality measure specifications
  • Proficient with MS software programs (Excel, Visio, PowerPoint, etc.)
  • If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders

Preferred Qualifications:

  • Master's degree in related fields
  • 5+ years of experience in Health Care, Understanding of Medicare Advantage
  • 3+ years of experience working in Stars at a large national plan
  • Experience and expert level knowledge in HEDIS operations, with extensive knowledge of specifications, reporting methodology, Medical Record Review operations, supplemental data integration, and HEDIS reporting requirement
  • Skilled in communication and keeping teams updated
  • Ability to work in a fast paced, complex organization
  • Strong interpersonal skills and ability to interact collaboratively with internal business partners across multiple departments and business segments

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care 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)

Colorado Residents Only: The salary range for Colorado residents is $79,700 to $142,600. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer 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 law.

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

Job Keywords: Medicare Stars Analytics Consultant, SQL, SAS, Business Analytics, Data Analytics, Healthcare Analytics, Data Visualization, Excel, Tableau, Relational Databases, Stars, HEDIS, Medicare Advantage, Optum at Home, OAH, DSNP, ISNP, Telecommute, Telecommuting, Telecommuter, Work From Home, Work At Home, Remote, WAH

Medicare Stars Analytics Consultant - Telecommute

United Health Group
Washington, DC
Full Time

Published on 11/24/2021

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