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Field Senior Clinical Quality Rn

2+ years
Not Disclosed
10 Oct. 30, 2024
Job Description
Job Type: Full Time Education: B.Sc./ M.Sc./ M.Pharm/ B.Pharm/ Life Sciences Skills: Causality Assessment, Clinical SAS Programming, Communication Skills, CPC Certified, GCP guidelines, ICD-10 CM Codes, CPT-Codes, HCPCS Codes, ICD-10 CM, CPT, HCPCS Coding, ICH guidelines, ICSR Case Processing, Interpersonal Skill, Labelling Assessment, MedDRA Coding, Medical Billing, Medical Coding, Medical Terminology, Narrative Writing, Research & Development, Technical Skill, Triage of ICSRs, WHO DD Coding

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 for the better. Join us in building the health care system of tomorrow—one that is more responsive, affordable, and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

Position Overview:

The Senior Clinical Quality RN will focus on tasks that align with State, CMS, and other applicable requirements. This role involves providing direction and guidance on provider-focused clinical quality improvement and management programs.

You will assist contracted providers with analyzing member care, tracking quality compliance at the provider level, and developing action plans to support continuous quality improvement using clinical practice guidelines, HEDIS, CMS, NCQA, and other tools. This position reports to the Quality Leadership of the Health Plan.

Location:

This is a home-based office position with field responsibilities up to 75% of the time. Travel will include counties in Kansas based on business needs. If you reside in Kansas City, KS, or surrounding counties, you will have the flexibility to telecommute.

Primary Responsibilities:

  • Support program deployment at the practice level through strategic partnerships with practitioners and practice staff, assessing trends in quality measures and identifying improvement opportunities.
  • Serve as a subject matter expert (SME) for assigned HEDIS/State Measures and lead efforts to design educational materials for practitioner offices.
  • Represent the Health Plan at community events focused on quality improvement and member health education.
  • Perform onsite clinical evaluations through medical record audits, ensuring compliance with quality metrics and standards.
  • Investigate gaps in clinical documentation impacting rate calculation and provide feedback to relevant team members.
  • Advise providers on standards of care, established clinical guidelines, and appropriate documentation and billing practices.

Why Consider UnitedHealth Group?

We offer competitive base pay, comprehensive benefits, performance rewards, and a management team dedicated to your success. Our offerings include:

  • Paid Time Off, including 8 Paid Holidays
  • Medical, Dental, and Vision Plans
  • 401(k) Savings Plan and Employee Stock Purchase Plan
  • Education Reimbursement
  • Employee Discounts and Assistance Programs
  • Voluntary Benefits (pet insurance, legal insurance, etc.)

Required Qualifications:

  • Current unrestricted RN licensure in the state of Kansas
  • 2+ years of clinical experience as an RN
  • 2+ years of experience in quality improvement
  • Intermediate proficiency in MS Office (Word, Excel, Outlook)
  • Current Kansas driver’s license and insurance
  • Access to reliable transportation for travel (up to 75%)
  • Designated quiet workspace at home with the ability to secure Protected Health Information (PHI)
  • High-speed internet connection

Preferred Qualifications:

  • BSN or Master’s Degree in a clinical field
  • HEDIS and NCQA experience
  • Experience leading teams for better quality outcomes
  • Background in Managed Care and the health care insurance industry

All telecommuters must adhere to UnitedHealth Group’s Telecommuter Policy.

At UnitedHealth Group, our mission is to help people live healthier lives and improve the health system for everyone. We are committed to addressing health disparities and delivering equitable care.

Diversity and Inclusion:

UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer. We welcome applicants from all backgrounds and do not discriminate based on 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.

Drug-Free Workplace:

Candidates are required to pass a drug test before beginning employment.

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