LVN QI Specialist

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start **Caring. Connecting. Growing together.** Works in collaboration with the Regional Accountable Teams (RATs), Site Accountable Teams (SATs), regional QI Specialists, Provider Services and Risk Management to fulfil their cross-regional accountability for the performance of clinical site reviews and chart audit of non-group models (i.e., IPA physician/practitioner offices) as part of the initial credentialing and re-credentialing process. Generates Corrective Action Plans and monitors improvements as required. **Provides Direction To:** Licensed Practical Nurses, clerical assistants, medical assistants, and other non-licensed personnel. **Primary Responsibilities:** + Clinical Knowledge and Skills + Consistently exhibits behavior and communication skills that demonstrate Optum's commitment to superior customer service, including quality, care and concern with each and every internal and external customer + Schedules and conducts site reviews and chart audits for new clinicians and as part of the re-credentialing process and/or as necessary in accordance with NCQA, Optum and other applicable regulatory standards + Prepares, delivers and follows-up on Corrective Action Plans for sites not meeting the required critical elements of the site review and audit process + Forwards all necessary documentation to Provider Services + Provides regional QI office with copies of completed site review tool, chart audit tool and Corrective Action Plans including any or all ongoing communication and/or documentation + Collaborates with the QI staff and/or with Provider Services with suggestions for revision to tools used for site review and/or chart audit and the implementation of revisions + Assists regional QI Specialists with chart audit of group model providers as part of the credentialing process and as it contributes to the Provider Performance review (PPR) + Maintains data as necessary to identify clinicians who have failed to reach a score of 80% in each section of the chart review and an overall score of 89%. Clinicians in this category will be reviewed yearly + Maintains the confidentiality of site review and chart audit-related information + Assists in the preparation of accreditation and other regulatory reviews + Collaborates with QI Specialists and QI Coordinators on projects as requested by the Director, Quality Improvement + Uses, protects, and discloses Optum patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards + Performs additional duties as assigned + Communication + Maintains open lines of communication with physicians and other Optum Medical personnel including site leadership, within and between departments + Maintains confidentiality of all information obtained from patient records and conversations with patients/significant others, physicians, and other Optum Medical personnel + Uses discretion and sensitivity during all phone conversations + Uses a non-judgmental approach when talking with patients and coworkers + Uses available electronic mail/computer systems to communicate inter- and intra-departmentally as per departmental and/or Optum Medical protocol(s) + Organizational Skills + Work area reflects neat and organized work habits + Sets priorities effectively to ensure timely completion of assigned work + Requests assistance as appropriate in order to complete assigned work and offers to assist others when work load permits + Prepares and leaves complete, concise messages/instructions for others as needed + Uses time, supplies, and human resources effectively and efficiently + Documentation + Complete and accurate documentation summarizing site visits + Following Practice Health and Safety policies and procedures to give guidance in improving staff practice and flow + Leadership + Demonstrates effective problem-solving skills, particularly when urgent/emergent or unexpected clinical or administrative events arise in order to maintain both the smooth functioning of the department and patient/personnel safety + Serves as a catalyst for improving standards of nursing practice + Demonstrates leadership skills through the ability to set and attain goals + Serves as an effective role model for professional conduct and professional practice (e.g., maintaining composure during times of increased stress) + Provides direction and support, and delegates tasks to professional and non-professional staff + Serves as an effective preceptor to new staff as needed + Actively participates in departmental staff meetings + Professionalism + Demonstrates self-direction, accountability, sound judgment, and ethical behavior in all activities + Demonstrates patient advocacy + Maintains a commitment to the spirit of inquiry as evidenced by a clinical knowledge base that remains current and reflects understanding of relevant clinical research findings + Other Specific Responsibilities/Duties + Required Travel 75% of time + Arrives to work on time or notifies Supervisor or designee as soon as employee becomes aware that s/he will be absent or tardy, and/or as per individual department protocol + Maintains an acceptable attendance record as per Optum Medical policies and procedures + Notifies Supervisor or designee whenever leaving Optum Medical premises during scheduled work hours + Attends all mandatory meetings and in-services + Dresses according to Optum Medical dress code + Assumes responsibility for reading, understanding, and complying with information contained in the current Optum Medical Employee Handbook, Optum Medical Clinical and/or Administrative + Policy & Procedure Manuals, as applicable + Maintains patient confidentiality under all circumstances and follows all Optum Medical policies regarding confidentiality + Assists Supervisorr and/or designee, and/or other administrative personnel, when possible, by taking on alternate assignments or other responsibilities, working additional hours, or altering regularly scheduled hours, when necessary, for the efficient operation of Optum Medical 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:** + 1+ years of post-high school education or a degree from a two-year college + Current California LVN license + Current Basic Life Support from American Heart Association **Preferred Qualification:** + Supervisor and/or Team Lead experience The hourly range for this role is $19.86 to $38.85 per hour 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. _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._ _UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._