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Senior Clinical Quality Nurse
2 months ago
At UnitedHealthcare, we're committed to simplifying the healthcare experience and creating healthier communities. As a Senior Clinical Quality RN, you'll play a vital role in improving the quality of care for our members.
Key Responsibilities:- Support the effective deployment of quality improvement programs at the practice level through strategic partnerships with participating practitioners and practice staff.
- Serve as a subject matter expert for assigned HEDIS/State Measures, preventive health topics, and lead efforts with the clinical team to research and design educational materials for use in practitioner offices.
- Participate in community-based organization events, clinic days, health department meetings, and other outreach events focused on quality improvement, member health education, and disparity programs.
- Coordinate and perform onsite clinical evaluations through medical record audits to determine appropriate coding and billing practices, compliance with quality metrics, and compliance with service delivery and quality standards.
- Investigate gaps in clinical documentation where system variation has an impact on rate calculation, provide feedback to appropriate team members where issues are verified, and monitor resolution to conclusion.
- Current unrestricted RN licensure in the state of Kansas.
- 2+ years of clinical experience as an RN.
- 2+ years of experience with quality improvement.
- Intermediate level of proficiency in MS Office, including Word, Excel, and Outlook.
- Current, non-restricted state of Kansas driver's license and state-required insurance.
- Access to reliable transportation and the ability to travel up to 75% of the time to providers.
- Access to a designated quiet workspace in your home (separated from non-workspace areas) with the ability to secure Protected Health Information (PHI).
- Live in a location that can receive a UnitedHealth Group-approved high-speed internet connection or leverage an existing high-speed internet service.
- BSN, Master's Degree (or higher) in a Clinical Field.
- HEDIS; NCQA experience.
- Experience leading teams or individuals for better quality outcomes.
- Healthcare and insurance industry experience, including regulatory and compliance.
- Background in Managed Care.
UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer. 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.
