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Senior Clinical Long Term Care Quality of Care RN
3 months ago
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.
Position is based in Mohave County, Arizona and will require travel up to 25% of the time in Arizona.
If you are located in Arizona, you will have the flexibility to work remotely*, as well as work in the office 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
- 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.
Required Qualifications:
- 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
- Long-term care nursing experience
- 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
- Resident of Arizona
- Willing or ability to travel 25% of the time within the state of Arizona, as needed
Preferred Qualifications:
- 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
*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
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.
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.
