Senior Clinical Quality of Care RN - Telecommute in Arizona
Location: Phoenix, Arizona
Internal Number: 111147445
UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm)
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.
If you are located in Arizona, and are willing to travel up to 25% of the time, you will have the flexibility to telecommute* as you take on some tough challenges.
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
Work independently while utilizing good critical thinking skills, as well as excellent verbal and written communication skills
Occasional on-site provider visits may be required for potential Quality of Care concerns
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.
Active, unrestricted RN license in the state of Arizona
5+ years of experience working as a Registered Nurse
1+ years of hospital experience as a Registered Nurse
Experience evaluating and auditing medical records
Intermediate skills in Microsoft Office, Word, and Excel ability to work with multiple data bases to retrieve and enter information
Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation
Long-term care nursing experience
Quality Management experience in a healthcare setting
Experience analyzing information and preparing written summaries
Experience working in a deadline driven environment prioritizing responsibilities
Knowledge of Medicare/Medicaid regulations
To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.
Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.(sm)
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
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.