RN - Clinical Quality of Care - Phoenix, AZ

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm)The Clinical Quality of Care RN will be responsible for conducting quality of care (QOC) investigation, review and management of the regulatory Incident/Accident/Death (AD) 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.This is an office-based position located at 1 East Washington Street in Phoenix.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

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

Long term care experience

5+ years of experience working as a Registered Nurse

1+ years of hospital experience as a Registered Nurse

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

If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders

Preferred Qualifications:

Knowledge of Medicare/Medicaid regulations

Quality Management experience in a healthcare setting

Experience analyzing information and preparing written summaries

Experience working in a deadline driven environment prioritizing responsibilities

Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV / AIDS and high - risk pregnancy. Our holistic, outcomes - based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.(sm)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: Quality RN, Registered Nurse, RN, Quality of Care, QOC, CPC, Clinical Practice Consultant, Audit, Medicare, Medicaid, Healthcare, Managed Care, Phoenix, AZ, Arizona