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Positions in this function are responsible for direction and guidance on clinical quality improvement and management programs including accreditation. Conducts clinical quality audits and may also be responsible for NCQA requirements. Responsible for the reporting and analysis of member care quality and for the development of plans and programs to support continuous quality improvement.
You’ll enjoy the flexibility to work remotely
- from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities :
Review and audit contracted sub-delegatesAssist with report preparation and records regarding work function activities and projectsSupports Medical Management Initiatives with quality improvement. Included but not limited to these departments : case management, utilization management programs and Medical Director Initiatives)Participates in and represents the Clinical Quality Team by collaborating with internal business partners focusing on quality improvementParticipates in or coordinates with other departmental projects as neededEducation to staff or contracted entities as neededPerforms other duties as assignedProfessional Competencies :
Working knowledge of health care delivery systemsWorking knowledge of PC applications including MS Office Suite.Ability to use written and oral communication skillsAbility to read and interpret dataSkill in writing clear, grammatically correctEasy to use instructional documentationAbility to identify learning needs, set goals and seek educational opportunitiesAbility to analyze problems and formulate appropriate plans, solutions, and courses of actionKnowledge of age specific communication needs with the ability to listen actively and respond to internal and external customers in a timely, competent manner both verbally and nonverballyAbility to work with frequent interruptionsAbility to establish and maintain cooperative working relationships with individuals at all levels of the organization and affiliatesAbility to maintain confidentiality of patient and all related entity business matters of the organization and its partnersAbility to manage detail and work with accuracyAbility to recognize and act appropriately in situations where patient care needs exceed scope of practiceSkill in working with a team and the ability to collaborate on projects with colleaguesSkill in working effectively under deadlines and changing prioritiesSkills :
All staff members are to promote a positive and productive work environment by acting maturely and responsibly, satisfactorily performing his or her job responsibilities and conducting themselves in a professional, courteous and respectful manner toward fellow employees, physicians and patientsMust hold relationships to a high standard- respectful approach to all people and interactions, listening to understand, take emotional accountability and exemplify balance of self with all interactions, be receptive to feedback and opportunities keeping an open mind towards growthIntegrates Lean principles, practices and tools to improve operational efficiency, reduce costs and increase customer satisfactionFollows written and oral instructions and completes routine tasks independentlyCompletes annual compliance training on HIPAA / Privacy / Confidentiality / Non-Discrimination / Harassment / Integrity Statement and signed AgreementsEnsures confidentiality of patient information following HIPAA guidelines and company policiesAttends training to meet requirements of the job position and as needed or mandated by company policies and regulationsHas regular and predictable attendanceYou’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 license5 years of clinical experience1 years of clinical quality experience1 years working in managed care or in the insurance industryExperience with Medicare and / or MedicaidKnowledge base of clinical standards of care, preventive health standards, HEDIS, NCQA, governing and regulatory agency requirementsProficiency in software applications that include, but are not limited to, Microsoft Word, Microsoft Excel, Microsoft PowerPoint. Teams and OutlookProven ability to evaluate medical records with attention to detail to perform quality auditsProven solid organizational skills, self-motivated and ability to interact with company staff at all levelsAccess to a safe quiet space to work as a telecommuterPreferred Qualifications :
Subject matter expert for CMSExperience with project coordinationDemonstrated ability to assist with focusing activities toward a strategic direction as well as develop tactical plans, drive performance and achieve targetsDemonstrated ability to do formal presentations in different settings- internal / external auditors, reporting on projects and reports that have been created and analyzedAll employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter PolicyThe salary range for this role is $59, to $, 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 k 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.
Application Deadline : This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
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 : OptumCare 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.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Salary : $59
