- Implement and maintain data bases necessary to complete standard reportable event reports and analysis within agreed upon deadlines surrounding the HCBS LTSS population
- Complete ad hoc reports and analysis as requested by State partner or internal LTSS leadership
- Routinely analyze results of reportable event submissions, substantiations, and CAPs to identify trends such as (provider issues, coordinator issues, other)
- Manage assigned special projects to completion within target date
- Utilize reportable event system tools / databases / SharePoint to capture relevant data and document corrective actions
- Support continuous improvement efforts to increase capacity and efficiency
- Utilize change management to drive results
- Develop recommendations for quality remediation plans
- Share best practices and support team goals and objectives
- Drive consistency and efficient processes on the team
- Actively participate in reportable event quality improvement initiatives / meetings
- Responsible for maintaining and increasing self-proficiency in the use of quality tools and methods and the application of quality science
- Interface with many internal clinical and provider relations staff and external providers to gather quality concern information for quick turn-a-round state reporting to avoid liquidated damage
- High School diploma or GED equivalent
- 2+ years of experience working within a Health Care or Managed Care environment
- Solid experience in tracking and trending reportable data
- Solid computer skills including the ability to create and manipulate Excel spreadsheets
- Experience working in proprietary software systems
- Bachelor s degree
- Experience in a Managed Long Term Services and Supports (MLTSS) environment
- Medical record review experience
- Knowledge of health care products, delivery systems, claims processing and supporting systems
- Knowledge of quality improvement methods and tools (SPC, Six Sigma, LEAN)
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Reportable Events Analyst, Long Term Services and Supports - Brentwood, United States - UnitedHealth Group
Description
At UnitedHealthcare, we re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.
The Reportable Events Analyst, Long Term Services and Supports, receives, investigates, and maintains all reportable events, including potential quality of care and quality of services concerns; to ensure the health, safety, individual freedom, and quality of life of people participating in home and community-based services (HCBS) and ICF/IID services. This position is responsible for timely submissions to the Bureau of TennCare and the Tennessee Department of Intellectual and Developmental Disability (DIDD) for reportable events surrounding the 14th amendment to the TennCare Contractual Risk Agreement (CRA) and One System Reportable Events Management (REM) Protocol. This individual will track and trend information to assist in the application and interpretation of data to drive quality improvement efforts and will assist in development of contractual deliverables to the State as called upon.
Primary Responsibilities:
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:
Preferred Qualifications:
*All employees working remotely will be required to adhere to UnitedHealth Group s Telecommuter Policy
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.
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.
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