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About UHG

Careers at UnitedHealth Group

 

We have modest goals: Improve the lives of others. Change the landscape of health care forever. Leave the world a better place than we found it. Such aspirations tend to attract a certain type of person. Crazy talented. Compassionate. Driven. To these individuals, we offer the global reach, resources and can-do culture of a Fortune 5 company. We provide an environment where you’re empowered to be your best. We encourage you to take risks and in return, offer a world of rewards and benefits for performance. Exceeding your limits is an exceptional start to your life's best work.SM

 

Just like you, we are driven by a set of fundamental principles that are guiding our way forward. Our values of integrity, compassion, relationships, innovation, and performance serve as a foundation to transform health care. Are you in? Learn more about your future at UnitedHealth Group at careers.unitedhealthgroup.com

 

Job Category:

Nurse

Country:

US

Approximate Salary:

Not Specified

Position Type:

Full Time

Sr Clinical Quality Nurse - Quality Solutions Delivery Clinical Review - Telecommute US

UHG - St. Louis, Missouri

Posted: 10/20/2018

UnitedHealthcare’s Quality Solutions Delivery is an integrated team serving all UnitedHealthcare businesses, focused on delivering operational efficiencies for centralized activities. 

 

Quality Solutions Delivery combines talented individuals from many areas of quality. Our goal is extraordinary performance that exceeds the expectations of the constituents, customers and members we serve.

 

This position reports to the Manager, QSD Clinical Review. 

 

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

 

Primary Responsibilities:

  • Contribute to annual project plan to achieve all Clinical Review tasks and objectives

  • Observe and comply with policies and procedures for assigned scope:

    • Rate Maximization

    • Quality Assurance

    • Vendor Inter-Rater Reliability (VIRR)

    • Medical Record Review Validation (MRRV)

    • Inter-Rater Reliability (IRR)

    • Abstraction (medical chart interpretation and data entry)

  • Complete and pass all training programs and testing for all clinical review staff

  • Maintain expertise on all measures within HEDIS®/Stars and required performance guarantee or custom state measure requirements in Quality Solutions Delivery’s scope

  • Be fully versed and trained on all HEDIS® Software, Onbase & rateLIFT

  • Participate in all User Acceptance Testing (UAT) pertaining to HEDIS® Software, Onbase and rateLIFT

  • Support and participate in implementation of process improvement project initiatives

  • Uphold UnitedHealthcare Cultural Values

  • Other areas, as determined by Manager

     

    For Clinical Review Group assignment:

  • Conduct Quality Assurance on Rate Maximization work, Inter-Rater Reliability assessments on all internal abstraction staff as well as participate in Medical Record Review Validation:

    • Identify, document and communicate trends with any abstraction concerns

    • Ensure errors identified are taken to resolution

  • Ensure all charts are pulled and documented to support final MRRV audits

    • Support any corrective action plans, if required

  • Conduct analysis of retrospective operations and engage teams to identify improvements

  • Implement process improvements annually

  • Conduct year round abstraction and IRR activities for all charts collected internally (within volume scope)

  • Engage in training development and beta testing, as appropriate


 Required Qualifications:

  • Current, unrestricted RN or LPN license
  • Minimum 2 year degree or equivalent experience  
  • Clinical and/or Health Education experience
  • 3+ years’ of Healthcare/Health Plan experience
  • Experience with HEDIS® measures
  • 2+ years’ of proven success auditing quality programs
  • Demonstrated ability to assist with focusing activities toward a strategic direction and achieve targets
  • Intermediate to advanced proficiency with Microsoft Office applications, including: Word, Excel and PowerPoint

Preferred Qualifications:

  • 4 year degree or equivalent experience
  • Basic statistical knowledge and application of continuous quality improvement concepts, such as Six Sigma or PDCA 

Soft Skills:

  • Excellent team development skills
  • Strong interpersonal skills
  • Strong time management and prioritization skills
  • Strong written and verbal communications skills
  • Strong analytical skills

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that’s second to none. This is no small opportunity. It's where you can do your life's best work.(sm)

 

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy

 

 

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.

 

 

Keywords: RN, Registered Nurse, LPN, LVN, Healthcare, health plan, QSDS, Clinical, Audit, HEDIS, NCQA, QI, PDCA, quality improvement, QA, education, Six Sigma, telecommute, Boston, MA, Massachusetts, Philadelphia, PA, St. Louis, MO, Missouri, Nashville, TN, Tennessee, Providence, RI, Rhode Island

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