Clinical Quality RN - Remote MST
About The Position
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 Clinical Quality RN will be responsible for conducting quality of care (QOC) investigation, review and management of the regulatory Incident/Accident/Death (IAD) portal, documenting and communicating findings from these reviews, and preparing reports or summaries for internal and external customers. This position collaborates with the Chief Medical Officer or other Medical Directors to review QOC and other investigations and ensures that QOC investigations comply with all applicable State, Federal, and regulatory requirements. These activities are used to ensure care and services provided to our members are timely, adequate, and compliant with regulatory and professional standards and guidelines. If you are willing to work 8:00am - 5:00pm Mountain Standard Time zone, you will have the flexibility to work remotely as you take on some tough challenges.
Requirements
- Active, unrestricted RN license in the state of Arizona or compact license
- 5+ years of experience working as a Registered Nurse
- 2+ years of hospital experience as a Registered Nurse
- Experience evaluating and auditing medical records
- Demonstrated intermediate skills in Microsoft Office, Word, and Excel ability to work with multiple databases to retrieve and enter information
- Demonstrated excellent writing skills - ability to analyze information and prepare written summaries
- Willingness to work a shift of 8am – 5pm Mountain Standard Time
Nice To Haves
- 1+ years of experience in quality management and clinical quality investigations, or equivalent experience
- Proven knowledge of Medicare/Medicaid regulations
- Demonstrated solid understanding of quality improvement principles and practices
- Experience working in a deadline driven environment prioritizing responsibilities
- Experience in Behavioral Health Services
Responsibilities
- Perform clinical documentation review of inpatient and outpatient care delivered to adults and children with Medicaid, Medicare health care benefits through Arizona United Health Care Community Plans for peer review and internal investigations of Quality of Care concerns
- Create professionally written case investigation summaries for Peer Review, present case summaries at the Provider Advisory Committee as applicable
- Review plans of correction from providers in response to a substantiated QOC occurrence
- Effectively interface with external customers, facilities, members and providers to resolve quality of care concerns, obtain medical records and other information
- Conduct delegated oversight reviews of contractors that perform work on behalf of UnitedHealthcare. This includes reviewing samples of contractor work against an audit tool or information found in medical charts
- Collaborate internally with Medical Directors and staff in other UHCCP departments
- Manage multiple tasks and projects and changing priorities; prioritize work products effectively
- Maintain timeliness for deliverables and regulator requests
- Be able to work independently, good critical thinking skills, excellent verbal and written communication skills
Benefits
- comprehensive benefits package
- incentive and recognition programs
- equity stock purchase
- 401k contribution
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
