Optum in the tri-state region (formerly CareMount Medical, ProHEALTH New York and Riverside Medical Group) offers an interconnected network that enables us to work collaboratively to better coordinate care among our doctors and care teams. Together, we offer you and your family access to more than 2,100 providers, representing 70 specialties, working in 360 medical practices and more than 55 urgent care locations across New York, New Jersey, and Southern Connecticut. For more information, visit www.optum.com/tri.

ProHealth is one of the largest private multi-specialty medical practices in the Northeast and has been serving the health needs of Long Island and the Greater New York Metropolitan area since 1997. With over 900 providers in 300 locations, our goal is to provide quality health care to ensure that our patients get the right care at the right time.

At Optum, we are transforming healthcare nationally while providing physician-led care locally. Work with the largest care delivery organization in the world and start doing your life's best work.(sm)

One of five regions in the Optum nationwide network, Optum Tri-State comprises three large multispecialty groups, CareMount Medical, ProHEALTH NY, and Riverside Medical Group. Optum Tri-State brings patients local care, backed by national expertise. As a premier provider of health care services, Optum Tri-State offers services including primary care, urgent care, a diverse range of specialty care, outpatient surgery, and imaging. The regions draws on the knowledge of leading doctors and healthcare experts to help 1.6 million patients across 630 locations access high quality, affordable healthcare within their community.

Optum’s Tri-State Value Business aims to improve the experience of care, improve the health of populations, and reduce the total cost of care. The Value Business is responsible for the performance of Medicare global capitation contracts for two risk entities: OptumCare Network of New Jersey (OCN NJ) and Optum IPA of New York (ONY). CareMount, ProHEALTH, and Riverside physicians participate in and contribute patients to these risk entities, and the Value Business innovates, coordinates, and delivers programs to achieve positive clinical and financial outcomes. Additionally, the Value Business is responsible for commercial quality incentive contracts that reside with these groups. Achieving success in value-based programs requires engagement and strategic alignment across the entire Tri-State organization, and clinical operations, physician leadership, finance, and our other Tri-State teams collaborate to ensure patients are receiving high-quality, coordinated care.

The HEDIS/STARS Associate is responsible for supporting evolving population health initiatives designed to improve the quality of care provided to Optum Tri-State patients. Reporting to the Manager of Medicare STARS, the HEDIS/STARS Associate supports all aspects of payor quality programs including those administered by The Centers for Medicare and Medicaid Services (CMS), Medicare Advantage (MA), and commercial payors. The HEDIS/STARS Associate completes the review, abstraction, and submission of patient charts to payors; and supporting special projects designed to improve patient experience and quality outcomes. The HEDIS/STARS Associate serves as a subject matter expert on quality measure stewards including CMS and Healthcare Effectiveness Data and Information Set (HEDIS). As an integral part of the Quality Team, the HEDIS/STARS Associate has a commitment to continual learning.

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

Primary Responsibilities:
The duties listed below are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or a logical assignment.

• Operations:
  • Supports all aspects of payor quality programs including those administered by The Centers for Medicare and Medicaid Services (CMS), Medicare Advantage (MA) and commercial payors. Leads day-to-day activities for payor quality programs including chart review, abstraction, and submission
  • Reviews and updates patient charts with historical data, as required
  • Serves as a subject matter expert on CMS and HEDIS quality measure specifications. Demonstrates a commitment to continual learning
  • Supports the annual NGACO Web Interface quality submission, MIPS attestations, and other efforts to submit supplemental quality data to payors continuously throughout the year
  • Supports special projects to promote enhanced patient experience and quality outcomes
  • Participates in data validation for EHR reports as required
  • Attends and participates in quality team meetings and educational sessions
  • Fosters innovative problem solving and upholds principles of continuous quality improvement
  • Assists in the resolution of issues and elimination of roadblocks to ensure timely completion of tasks
• Other - Performs other 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.

Required Qualifications:

• High School degree
• Proficiency in the use of Microsoft Office applications: Word, Excel, and Outlook and the ability to learn and apply new technologies and skills
• Proven solid interpersonal skills and an understanding of and commitment to patient-centered medical care with a team-based approach
• Proven solid organizational skills, and a demonstrated ability to maintain accurate notes and records
• Proven ability to manage multiple and simultaneous responsibilities, work independently, exercise creativity, and is detail-oriented
  

Preferred Qualifications:

• Associate’s degree
• 3+ years of experience in clinical or community health settings
• Experience with Electronic Health Records Microsoft Excel, and working with practices around CMS and HEDIS quality measures
• Knowledge of CMS and HEDIS quality measures
  

CareMount Medical, ProHEALTH Care Associates, and Riverside Medical Group (the “Practices”) are all physician owned and led practices having complete authority for all medical decision-making and patient care through their physicians and other licensed professionals. Optum, through its management organizations (“Optum”) provides non-clinical administrative services to support the Practices and their physicians. Neither Optum nor its management companies employ, engages, or supervises physicians or other licensed professionals, or determines or sets the methods, standards, or conduct of the practice of medicine or health care provided by the Practices or by any of their licensed professionals. “Part of Optum” reflects that the Practices are part of Optum’s effort to support forward-thinking physician practices in helping their patients live healthier lives.

Careers with Optum. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges.

California, Colorado, Connecticut, Nevada, New York, Rhode Island, or Washington Residents Only: The hourly range for California, Colorado, Connecticut, Nevada, New York, Rhode Island or Washington residents is $18.80 to $36.78. 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 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.