UnitedHealth Group Sr Clinical Quality Nurse - Quality Solutions Delivery Clinical Review - Telecommute US in St. Louis, Missouri
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.
Contribute to annual project plan to achieve all Clinical Review tasks and objectives
Observe and comply with policies and procedures for assigned scope:
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 ManagerFor 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
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
4 year degree or equivalent experience
Basic statistical knowledge and application of continuous quality improvement concepts, such as Six Sigma or PDCA
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