Quality Improvement Nurse

Senior Clinical Quality of Care RNAt UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together.The Senior Clinical Quality of Care RN will be responsible for conducting quality of care (QOC) investigation, review and management of the regulatory Incident/Accident/Death (IAD) portal, documenting and communicating findings from these reviews, and preparing reports or summaries for internal and external customers. This position collaborates with the Chief Medical Officer or other Medical Directors to review QOC and other investigations and ensures that QOC investigations comply with all applicable State, Federal, and regulatory requirements. These activities are used to ensure care and services provided to our members are timely, adequate, and compliant with regulatory and professional standards and guidelines. These QOC investigations are specific to Arizona Medicaid and Medicare members. This position is an Arizona based remote position with the option of working 40% in-office. There is travel up to 25% of the time based on business needs. In-office may be required based on performance metrics. The office is located at 1 East Washington Street in Phoenix. If you reside in Arizona and be able to travel 25% of the time, you will have the flexibility to work remotely* as you take on some tough challenges.Primary ResponsibilitiesPerform clinical documentation review of inpatient and outpatient care delivered to adults and children with Medicaid, Medicare health care benefits through Arizona United Health Care Community Plans for peer review and internal investigations of Quality of Care concernsCreate professionally written case investigation summaries for Peer Review, present case summaries at the Provider Advisory Committee as applicableReview plans of correction from providers in response to a substantiated QOC occurrenceEffectively interface with external customers, facilities and providers to resolve quality of care concerns, obtain medical records and other informationConduct delegated oversight reviews of contractors that perform work on behalf of UnitedHealthcare. This includes reviewing samples of contractor work against an audit tool or information found in medical chartsCollaborate internally with Medical Directors and staff in other UHCCP departmentsManage multiple tasks and projects and changing priorities; prioritize work products effectivelyMaintain timeliness for deliverables and regulator requestsMust have the ability to work independently, good critical thinking skills, excellent verbal and written communication skillsOccasional on-site provider visits may be required for potential Quality of Care concernsRequired QualificationsActive, unrestricted RN license in the state of Arizona5+ years of experience working as a Registered Nurse2+ years of hospital experience as a Registered NurseExperience evaluating and auditing medical recordsProven intermediate skills in Microsoft Office, Word, and Excel ability to work with multiple data bases to retrieve and enter informationAbility to travel up to 25% within the state of ArizonaDriver's license and access to reliable transportationReside within the state of ArizonaPreferred QualificationsQuality Management experience in a healthcare settingExperienced with Behavioral Health ServicesExperience analyzing information and preparing written summariesExperience working in a deadline driven environment prioritizing responsibilitiesKnowledge of Medicare/Medicaid regulationsExperience with medical record review and identification of quality of care concernsAll employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter PolicyPay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $72,800 - $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.