Senior Clinical Quality of Care RN - Arizona

UnitedHealth Group•Tucson, AZ

8d•$35 - $63•Remote

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 Senior Clinical Quality of Care 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. These QOC investigations are specific to Arizona Medicaid and Medicare members. This position is an Arizona based remote position with the option of working 40%25 in-office. There is travel up to 25%25 of the time based on business needs. In-office may be required based on performance metrics. The office is located at 1 East Washington Street in Phoenix. If you are located within the state of Arizona, you will have the flexibility to work remotely as you take on some tough challenges. 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.

Requirements

Active, unrestricted RN license in the state of Arizona
5+ years of experience working as a Registered Nurse
2+ years of hospital experience as a Registered Nurse
Experience evaluating and auditing medical records
Proven intermediate skills in Microsoft Office, Word, and Excel ability to work with multiple data bases to retrieve and enter information
Ability to travel up to 25%25 within the state of Arizona
Driver's license and access to reliable transportation
Reside within the state of Arizona

Nice To Haves

Quality Management experience in a healthcare setting
Experienced with Behavioral Health Services
Experience analyzing information and preparing written summaries
Experience working in a deadline driven environment prioritizing responsibilities
Knowledge of Medicare/Medicaid regulations
Experience with medical record review and identification of quality of care concerns

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 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
Must have the ability to work independently, good critical thinking skills, excellent verbal and written communication skills
Occasional on-site provider visits may be required for potential Quality of Care concerns