Senior Clinical Quality RN - Arizona

At UnitedHealthcare, weâ€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.Â

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. Â

These QOC investigations are specific to Arizona Medicaid and Medicare members. Â

This position is an Arizona based remote position with the option of working 40% in-office. Â There is travel up to 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.

Primary 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 Â
• 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

Youâ€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 :

• 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% within the state of Arizona
• Reside within the state of Arizona

Preferred Qualifications :

• Quality Management experience in a healthcare setting
• Experienced with Behavioral Health ServicesÂ
• Experience analyzing information and preparing written summaries
• Experience working in a deadline driven environment prioritizing responsibilities
• Knowledge of Medicare / Medicaid regulations
• All employees working remotely will be required to adhere to UnitedHealth Groupâ€s Telecommuter Policy. Â

At 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.  Â

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. Â Â Â

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. Â Â