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    Field Senior Clinical Quality Rn

    Optum
    2+ years
    Not Disclosed
    Remote, USA
    10 Oct. 29, 2024
    Job Description
    Job Type: Full Time Education: B.Sc./ M.Sc./ M.Pharm/ B.Pharm/ Life Sciences Skills: Causality Assessment, Clinical SAS Programming, Communication Skills, CPC Certified, GCP guidelines, ICD-10 CM Codes, CPT-Codes, HCPCS Codes, ICD-10 CM, CPT, HCPCS Coding, ICH guidelines, ICSR Case Processing, Interpersonal Skill, Labelling Assessment, MedDRA Coding, Medical Billing, Medical Coding, Medical Terminology, Narrative Writing, Research & Development, Technical Skill, Triage of ICSRs, WHO DD Coding

    Job Opportunity: Senior Clinical Quality RN

    Location: Kansas City, KS (Remote with field responsibilities)
    Travel: Up to 75%

    About UnitedHealthcare

    At UnitedHealthcare, we’re dedicated to simplifying the health care experience and creating healthier communities. The work you do here has a positive impact on millions of lives. Join us in building a more responsive, affordable, and equitable health care system.

    Position Overview

    The Senior Clinical Quality RN will focus on ensuring compliance with state, CMS, and other regulatory requirements. This role involves guiding provider-focused clinical quality improvement initiatives and managing programs that analyze member care, trend quality compliance, and develop action plans for continuous quality improvement.

    Key Responsibilities:

    • Deploy quality improvement programs at the practice level, collaborating with practitioners and staff to assess trends and identify improvement opportunities.
    • Serve as a subject matter expert (SME) for HEDIS/State Measures and preventive health topics, leading educational material development for practitioners.
    • Participate in community-based events and outreach focused on quality improvement and member health education.
    • Conduct onsite clinical evaluations through medical record audits to ensure compliance with coding, billing practices, and quality metrics.
    • Investigate gaps in clinical documentation, provide feedback to team members, and monitor resolutions.
    • Advise providers on standards of care and established clinical practice guidelines.

    What We Offer

    • Competitive Salary & Benefits: Paid Time Off, Medical, Dental, Vision, Life Insurance, 401(k) Savings Plan, Education Reimbursement, Employee Discounts, and more.
    • Performance Rewards: Recognized for your achievements in a challenging environment that provides clear direction for success.
    • Growth Opportunities: Development for various roles within the organization.

    Required Qualifications:

    • Current unrestricted RN licensure in Kansas.
    • 2+ years of clinical experience as an RN.
    • 2+ years of experience in quality improvement.
    • Proficient in MS Office (Word, Excel, Outlook).
    • Current Kansas driver’s license and state-required insurance.
    • Reliable transportation and ability to travel up to 75%.
    • Designated quiet workspace at home to secure Protected Health Information (PHI).
    • High-speed internet connection.

    Preferred Qualifications:

    • BSN or Master’s Degree in a Clinical Field.
    • Experience with HEDIS and NCQA.
    • Leadership experience in quality outcomes.
    • Background in Managed Care and healthcare/insurance industry regulations.

    All Telecommuters must adhere to UnitedHealth Group’s Telecommuter Policy.

    Our Commitment

    At UnitedHealth Group, we believe everyone deserves the opportunity to live their healthiest life. We are committed to addressing health disparities and improving outcomes, reflecting our mission to make the health system work better for everyone.

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