DSNP RN Clinical Quality - Phoenix or Tucson, Arizona

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.If you are located in Phoenix or Tucson, Arizona, you will have the flexibility to work remotely* as you take on some tough challenges.

Travel is required about 25% of the time in the state.Primary Responsibilities : Telephonic and follow-up with members to close care gapsProvider outreach to address care gaps.

Following up with provider (via : fax, email, mail, phone call)Chart upload in Practice Assist to close care gapsSupport HEDIS chart chase efforts by reaching out to providers to retrieve medical recordsSupport STARS improvement projects, HEDIS, CAHPS measures and provide clinical guidanceSupport Health Plans as Subject Matter Expert of STARS and HEDIS Technical Specifications, project plans, and reporting logisticsIdentify and implement opportunities to improve rates or efficiency of data collectionSupport National Team effortsEducate providers on general policies and procedures applicable to delivery of careEducate providers on proper HEDIS documentation / coding for member complianceEngage providers to introduce new initiatives and monitor success of those in place and to identify issues and ensure effective problem resolution to maintain strong relationshipsServes as the primary point of contact, consultative resource, and subject matter expert in all aspects of medical record documentation requirements and coding as they apply to CMS Stars / HEDIS measuresClosely work with internal stakeholders and providers to engage members and close care gapsWeekly and monthly productivity reports for outreach (Corral, Provider Letter campaign, Compassion Cards)Ensure projects are completed on time and in scopeSupport the evaluation and monitoring of HEDIS / Stars specific QM MetricsMonitor of reports and playbookNeed to work independently and within an integrated team in a highly matrixed environmentAttend weekly / monthly and adhoc Webex meetings with national partners (National Star Operations Meetings, Stars Measure Meetings, and Various measure groups, etc.

Travel locally in Arizona (25%) to meet with provider groups and healthcare quality or policy organizationsYou’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 : Registered Nurse with no restrictions in state required to practice3+ years of experience working in a healthcare environment3+ years of experience of project management3+ years of experience in tracking, working with large data sets and making data-driven analytical decisions2+ years of Medicare, DSNP Lines of business2+ years of Stars, HEDIS measure technical specificationsExperience reaching out to member to close care gapsIntermediate or higher level of proficiency with Excel and PowerPoint, including visual representation of quality data and trends, use of basic math and statistics functionsAccess to reliable transportation with valid driver’s license that will enable you to travel to client and / or sites within designated areaCandidate must be based in Arizona (Phoenix, Tucson, or Mesa)Preferred Qualifications : UnitedHealth Group, Optum, or UnitedHealthcare experienceCommunity & State and or Medicare & Retirement experienceDemonstrated ability to communicate ideas clearly and conciselyFlexibility and quick adaptation to change is keyContinuous improvement mindsetExcellent time management, organizational, and prioritization skills and ability to balance multiple priorities*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter PolicyAt 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.