24 Senior Clinical Long Term Care Quality of Care RN - Pima County, AZ Jobs in Tucson, AZ
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Senior Clinical Long Term Care Quality of Care RN - Pima County, AZ
$83k-107k (estimate)
Full Time | Wholesale
2 Weeks Ago
UnitedHealthcare is Hiring a Senior Clinical Long Term Care Quality of Care RN - Pima County, AZ Near Tucson, AZ
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.Position is based in Arizona and will require travel up to 25% of the time in Pima County.
If you are located in Arizona, you will have the flexibility to work remotely*, as well as work in the office as you take on some tough challenges.
Primary Responsibilities
Required Qualifications
If you are located in Arizona, you will have the flexibility to work remotely*, as well as work in the office as you take on some tough challenges.
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
- Work independently while utilizing good critical thinking skills, as well as excellent verbal and written communication skills
- Occasional on-site provider visits may be required for potential Quality of Care concerns
Required Qualifications
- Active, unrestricted RN license in the state of Arizona
- 5 years of experience working as a Registered Nurse
- 1 years of hospital experience as a Registered Nurse
- Long-term care nursing experience
- Experience evaluating and auditing medical records
- Intermediate skills in Microsoft Office, Word, and Excel ability to work with multiple data bases to retrieve and enter information
- Resident of Arizona
- Willing or ability to travel 25% of the time within the state of Arizona, as needed
- Quality Management experience in a healthcare setting
- Experience analyzing information and preparing written summaries
- Experience working in a deadline driven environment prioritizing responsibilities
- Knowledge of Medicare/Medicaid regulations
- All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
Job Summary
JOB TYPE
Full Time
INDUSTRY
Wholesale
SALARY
$83k-107k (estimate)
POST DATE
06/09/2024
EXPIRATION DATE
06/30/2024
WEBSITE
cbgofcolorado.com
HEADQUARTERS
Colorado Springs, CO
SIZE
<25
INDUSTRY
Wholesale
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