Senior Clinical Quality RN

Senior Clinical Quality RN at Optum summary:
As a Senior Clinical Quality RN at Optum, you will provide telephonic, patient-centered clinical consults focusing on Care for Older Adults and Transition of Care post-hospital discharge. Your role involves reviewing patient charts to ensure adherence to clinical protocols, conducting assessments, and educating patients on health conditions while collaborating with healthcare providers. This position offers the flexibility to work remotely and aims to improve health outcomes through effective communication and quality patient engagement strategies.

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start

Caring. Connecting. Growing together.

The Clinical Performance Quality (CPQ) Clinical Programs Operations team supports Optum's Care Delivery Organizations by delivering patient-centered, clinically collaborative telephonic outreach to help people live healthier lives. Our team focuses on the design, execution, and delivery of telephonic and digital engagement strategies designed to close Medicare STARS/HEDIS gaps in care, including medication adherence, care for older adults, medication reconciliation post discharge, A1c, Blood pressure and statin therapy in patient with diabetes and cardiovascular disease. Our interdisciplinary service delivery team is comprised of Pharmacists, Registered Nurses, Pharmacy Technicians, and Care Coordinators.

The Registered Nurse will report into the Director of Clinical Programs. The Registered Nurse will perform telephonic, patient-centered clinical consults focused on Care for Older Adults annual pain and functional assessments. In addition, the RN will outreach telephonically for Transition of Care following hospital discharge to complete reviews as well as assist with appointment scheduling. The RN will be required to meet or exceed established productivity and quality metrics and work to support the hours of operation of the business (Mon-Fri 9am-6pm Central).

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Call center hours of operation are 9am-6pm CST.

Primary Responsibilities:

Strictly adheres to department's metrics and established advanced protocols and to handle incoming contacts including, but not limited to, prescription refill requests, lab results, x-ray results, medical inquiries, patient education and referral requests

Primarily to make outbound calls and will help manage the inbound call queue from patients, patient representatives, providers and other medical staff, while strictly adhering to established protocols and scripting

Review patient chart (in EMR) to ensure core measures are being addressed and met per protocol and takes appropriate action when they are not, i.e., schedule services

Complete patient assessments for Transition of Care Medication Reconciliation Post Discharge, Care for Older Adults Pain and Function Assessments

Educate patients on health conditions and necessity of routine screening and assisting with appointment scheduling (A1c, Controlling Blood Pressure, Breast Cancer Screening, Colorectal Cancer Screening, Diabetic Eye Exam, etc.)

Communicate with providers and offices to obtain needed evidence of completed lab work, screenings and care provided

Review available medical records for core measures to submit for closure of HEDIS/STARS measures

Assist patients with identification of and connectivity to community and program resources to assist with non-medical needs

Document thoroughly all calls and actions taken within core systems.

Performs all other related duties as assigned

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 Registered Nurse license in state of residency

Active Compact RN License (NLC) in

state of residency

Currently have or be able to obtain additional RN licensure in one or more of the following states: California, Connecticut, Nevada, New York, Oregon

5+ years of RN experience, including experience in a managed care setting

2+ years of experience in HEDIS/Star programs, preferably in a clinical quality consultant role

2+ years of call center experience

2+ years of experience with data analysis and/or quality chart reviews. Must be able to review paper and electronic medical records and charts

Experienced using Microsoft office applications, including databases, word-processing, outlook, and excel spreadsheets. Must be proficient in Excel

Solid knowledge of the Medicare HEDIS/Stars measures

Demonstrated ability to interact with medical staff, peers, and internal company staff at all levels

Demonstrated ability to manage multiple complex, concurrent projects

Proven excellent written and verbal communication and relationship building skills

Proven solid problem-solving skills; the ability to analyze problems, draw relevant conclusions and devise and implement an appropriate plan of action

Proven excellent customer service skills and communication skills

Preferred Qualifications:

Undergraduate degree or post graduate degree

Active, unrestricted Registered Nurse license in state of California

Bilingual in Spanish

Billing and CPT coding experience

Clinical data abstraction experience

Proven good business acumen, especially as it relates to Medicare

Demonstrated ability to be adaptable to change

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.

The salary range for this role is $71,600 to $140,600 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.

Application Deadline:

This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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.

Keywords:
Clinical Quality, Registered Nurse, Telehealth, Patient Care, HEDIS, Care Coordination, Health Outcomes, Chronic Disease Management, Remote Work, Medicare

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