Senior Clinical Quality of Care RN - Arizona
Company: UnitedHealthcare
Location: Glendale
Posted on: May 2, 2025
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Job Description:
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. -
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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. -
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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.
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If you are located within the state of Arizona, you will have the
flexibility to work remotely* as you take on some tough
challenges.
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Primary Responsibilities:
Perform 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 concerns
Create professionally written case investigation summaries for Peer
Review, present case summaries at the Provider Advisory Committee
as applicable
Review plans of correction from providers in response to a
substantiated QOC occurrence
Effectively interface with external customers, facilities and
providers to resolve quality of care concerns, obtain medical
records and other information -
Conduct 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 charts
Collaborate internally with Medical Directors and staff in other
UHCCP departments
Manage multiple tasks and projects and changing priorities;
prioritize work products effectively
Maintain timeliness for deliverables and regulator requests
Must have the ability to work independently, good critical thinking
skills, excellent verbal and written communication skills
Occasional on-site provider visits may be required for potential
Quality of Care concerns
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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:
Active, unrestricted RN license in the state of Arizona
5+ years of experience working as a Registered Nurse
2+ years of hospital experience as a Registered Nurse
Experience evaluating and auditing medical records
Proven intermediate skills in Microsoft Office, Word, and Excel
ability to work with multiple data bases to retrieve and enter
information
Ability to travel up to 25% within the state of Arizona
Driver's license and access to reliable transportation
Reside within the state of Arizona -
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Preferred Qualifications:
Quality Management experience in a healthcare setting
Experienced with Behavioral Health Services -
Experience analyzing information and preparing written
summaries
Experience working in a deadline driven environment prioritizing
responsibilities
Knowledge of Medicare/Medicaid regulations
Experience with medical record review and identification of quality
of care concerns
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*All employees working remotely will be required to adhere to
UnitedHealth Group's Telecommuter Policy. -
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The salary range for this role is $71,600 to $140,600 annually
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.
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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. - -
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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. - - -
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UnitedHealth Group is a drug - free workplace. Candidates are
required to pass a drug test before beginning employment. - -
Keywords: UnitedHealthcare, Mesa , Senior Clinical Quality of Care RN - Arizona, Healthcare , Glendale, Arizona
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