RN Clinical Quality Assurance
3 weeks ago
**About the Position**
UnitedHealth Group is seeking a skilled Clinical Quality RN to join our team. As a Clinical Quality RN, you will play a critical role in supporting quality audit activities for our operational clinicians, health plan partners, and regulatory agencies.
Main Responsibilities:
- Review Prior Authorization (PA), Inpatient Concurrent Review (IP), and/or Medical Claims Review (MCR) cases as assigned by the quality manager
- Use your knowledge of PA, IP, and/or MCR to 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
- Meet all assigned metrics and productivity goals while working independently
Required Qualifications:
- Active, unrestricted RN license in state of residence
- Knowledge of Curo and Care Advance medical management platforms
- Experience with Prior Authorization, inpatient concurrent review, or medical claims review
- Intermediate or higher proficiency with basic software applications including MS office, adobe, Smart Sheet
- Knowledge of CMS clinical guidelines, MCG, and InterQual
The salary for this role is estimated to be between **$58,300** and **$114,300** annually, depending on qualifications and location. Benefits include: comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution. UnitedHealth Group is committed to mitigating our impact on the environment and enabling equitable care that addresses health disparities and improves health outcomes.
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