Clinical Chart Abstractor - RN - Remote

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.

This role provides our client(s) chart-abstraction, electronic clinical quality measure (eCQM) measure validation & testing and performs case reviews/studies/quality measure clinical analysis including inter-rater reliability, common cause analysis, mortality reviews, AHRQ Patient Safety Indicator (PSI) events, and readmission/other measure or dashboard analysis and/or validation. This position requires an unrestricted RN license, not restricted to a particular state

Measured by:

• Submissions of chart-abstracted/eCQM measures to TJC and CMS (Hospital Inpatient/Hospital Outpatient/Inpatient Psych Facility Programs)
• Avoidance of CMS pay-for-reporting penalties or Joint Commission ORYX findings
• Improvement in CMS Overall Hospital Star Rating, and improvement in CMS quality-based program (Hospital Value-based Purchasing, Hospital-Acquired Condition Reduction and Hospital
• Readmission Reduction Program, other) measure outcomes & avoidance of pay-for-performance penalties

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

Primary Responsibilities:

• Ensuring the accuracy and completeness of abstracted data by following established protocols, guidelines, clinical documentation workflow, measure specifications, data dictionary definitions, data abstraction and collection methodology, and applicable use of vendor software and/or other methods to accomplish timely submissions
• Collaborating with healthcare providers and other members of the healthcare team to clarify documentation and ensure accurate interpretation for data abstraction
• Participating in quality assurance activities to monitor and improve data integrity and abstraction processes, and for improvement and in the development of systems that support clinical documentation of evidence-based care including but not limited to EHR's, documentation templates, data files, or other information systems
• Using professional judgment and advanced clinical knowledge collaborates on quality initiatives including but not limited to those to improve clinical information systems, interpret clinical specifications to support development and validation of clinical dashboards, eCQM QRDA measure files, and other data files
• Generating reports, summaries, and presentations based on abstracted data for various stakeholders, such as healthcare administrators, and regulatory agencies
• Staying current with knowledge of coding guidelines, regulations, quality-based program requirements, and best practices in data abstraction
• Ensuring compliance with relevant laws, regulations, and organizational policies related to data privacy and security
• Acting as a resource for existing and potential data sources to ensure the effectiveness and efficiency of valid and reliable data collection, aggregation, analysis, and reporting

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:

• Current, active, unrestricted Registered Nurse (RN) license in the U.S
• 3+ years of healthcare experience with knowledge and background in health system analyticsand/or quality management
• 2+ years of experience with operational processes and clinical decision making in the various providers within a health care delivery system(e.g., hospitals, medical groups, post-acute care organizations, physician practices, ambulatory surgical centers, etc.)
• Experienced using Microsoft office applications including Word, Power Point, Outlook, and Excel
• Proven excellent understanding of medical terminology, billing, CPT coding and ICD-10 coding rules

Preferred Qualifications:

• Experience with clinical data abstraction, eCQMs, data analysis and/or quality chart reviews. Must be able to review paper and electronic medical records and charts
• Proven excellent written and verbal communication and relationship building skills
• Proven excellent customer service skills

Qualified candidate will be expected to effectively demonstrate the following skills:

• Anticipates customer needs and proactively develops solutions to meet them
• Serves as a key resource on complex and/or critical issues
• Solves complex problems and develops innovative solutions
• Performs complex conceptual analyses
• Forecasts and plans resource requirements
• Provides explanations and information to others on the most complex issues
• Motivates and inspires other team members

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

The salary range for this role is $71,600 to $140,600 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

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