At 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 equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.The Senior Clinical Quality RN will focus on tasks that occur in accordance with State, CMS or other requirements as applicable. This position will also be responsible for direction and guidance on provider-focused, clinical quality improvement and management programs.This role assists contracted providers with analyzing member care, trending quality compliance at the provider level, and developing action plans and programs to support provider practices in continuous quality improvement using approved clinical practice guidelines, HEDIS, CMS, NCQA and other tools. Position reports to the Quality Leadership of the Health Plan.This is a home-based office position with field responsibilities up to 75% of the time. Travel to counties of Cherokee, Crawford, Bourbon, Linn, Miami, Johnson, Wyandotte, Douglas, Franklin, Anderson, Allen, Neosho, Labette, Montgomery, Wilson, Woodson, Coffey, Osage, Greenwood, Elk, and Chautauqua, KS based on business needs.If you are located within Kansas City, KS or surrounding counties you will have the flexibility to telecommute as you take on some tough challenges.Primary Responsibilities:
Supports effective deployment of program at the practice level through strategic partnerships with participating practitioners and practice staff while assessing trends in quality measures and identifying opportunities for quality improvement
Serves as subject matter expert (SME) for assigned HEDIS / State Measures, preventive health topics, leads efforts with clinical team to research and design educational materials for use in practitioner offices; serves as liaison with key vendors supporting HEDIS / State Measures; consults with vendors to design and implement initiatives to innovate and then improve HEDIS / State Measure rates
Participates, coordinates, and/or represents the Health Plan at community-based organization events, clinic days, health department meetings, and other outreach events focused on quality improvement, member health education and disparity programs as assigned
Coordinates and performs onsite clinical evaluations through medical record audits to determine appropriate coding and billing practices, compliance with quality metrics, compliance with service delivery and quality standards
Investigates gaps in clinical documentation where system variation has impact on rate calculation, provides feedback to appropriate team members where issues are verified, and monitors resolution to conclusion
Works with providers on standards of care, and advises providers on established clinical practice guidelines, and appropriate documentation and billing consistent with state specific measures and technical specifications
What are the reasons to consider working for UnitedHealth Group? Put it all together – competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:
Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
Medical Plan options along with participation in a Health Spending Account or a Health Saving account
Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
401(k) Savings Plan, Employee Stock Purchase Plan
Education Reimbursement
Employee Discounts
Employee Assistance Program
Employee Referral Bonus Program
Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
More information can be downloaded at: http://uhg.hr/uhgbenefits
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:
Current unrestricted RN licensure in state of Kansas
2+ years clinical experience as an RN
2+ years of experience with quality improvement
Intermediate level of proficiency in MS Office including Word, Excel, Outlook
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
Preferred Qualifications:
BSN, Master's Degree (or higher) in Clinical Field
HEDIS; NCQA experience
Experience leading teams or individuals for better quality outcomes
Health care and insurance industry experience, including regulatory and compliance
Background in Managed Care
Current, non-restricted state of Kansas driver’s license and state-required insurance
All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.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.Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer, and 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.UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.#RPO #Red
Full-time