Healthcare Quality Specialist
2 days ago
**Job Overview**
We are seeking a highly skilled Clinical Quality RN to support quality audit activities for our operational clinicians, health plan partners, and regulatory agencies. The Clinical Quality RN works under the supervision of the Manager of Clinical Quality to ensure that our operational teams meet all standards set forth by our health plan delegation agreements and regulatory agencies.
Main Responsibilities:
- Review PA, IP, and/or MCR cases as assigned by the quality manager
- Document observations about assigned cases using a structured scorecard or process
- Reference credible sources, such as job aids, policies, CMS criteria, MCQ, InterQual, when documenting feedback on cases
- Navigate medical management platforms (Curo, Care Advance) to review cases efficiently
- Communicate succinctly and professionally with peers, leaders, executives, and health plan and regulatory auditors
Salary:** $58,300 - $114,300 annually, depending on qualifications and location. Benefits include comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution. Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and welcomes candidates from diverse backgrounds.
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