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Sr Clinical Quality RN - Full-time / Part-time
| Hours | Full-time, Part-time |
|---|---|
| Location | Overland Park, KS Overland Park, Kansas |
About this job
There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Nursing here isn't for everybody. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Ready for a new path? Start doing your life's best work.(sm)
Primary Responsibilities:
The Sr. Clinical Quality RN is responsible for identifying opportunities for improvement (OFIs) in the clinical quality of the plan and improving OFIs targeted. Opportunities may come from such sources as the Consumer Assessment of Health Plans and Systems (CAHPS), HEDIS, as well as Potential Quality Issue (PQIs) referrals. Specific duties include:
- Lead projects for assigned quality measures including the development, implementation and timely completion of performance improvement initiatives for HEDIS measures, contract issues and monitoring of regulatory mandates.
- Improve access to care - assist in the development and implementation of monitoring of access and availability to services. Work with stakeholders to implement proactive strategies to address issues and measure impact using a PDSA model.
- Reduce inappropriate service use - assist in the development and implementation of monitoring appropriate use of service. Work with stakeholders to implement proactive strategies to address issues and measure impact using a PDSA model.
- Coordinate and perform onsite medical record reviews at provider offices to determine quality of care issues, resolve PQIs and report patterns or trends across the plan for compliance with service delivery and standards of care at all times.
- Educate providers on all aspects of plan clinical quality, including medical record review criteria (such as HEDIS), as well as new clinical guidelines, policies or procedures implemented by the plan.
- Participate in internal plan meetings relating to clinical quality and appropriate service use, including providing subject matter expertise to workgroups, taskforces and committees developed to ensure optimal plan functioning.
- Perform other duties and responsibilities as assigned
Requirements
Required Qualifications:
A current, valid and unrestricted RN licensure for the state of Kansas is required
2 years of RN clinical experience in an acute care or an outpatient setting is required
2 years of project management experience that includes tracking, planning projects, working with large data sets and managing changing priorities is required (seeking an individual contributor – as this is a non-managerial role)
Strong Microsoft Office (Word, Excel & Outlook) is required
Excellent verbal/ written communication skills to interact with internal company contributors and leadership, as well as, external state partners and stakeholders
Available for day time travel within the state of Kansas is required along with reliable transportation and valid auto insurance. Travel up to 25%.
Managed care experience; Medicaid experience a plus
UnitedHealthcare, part of the UnitedHealth Group family of companies, is comprised of three specialized businesses dedicated to meeting the health care benefits needs of individuals and groups; all part of something greater, but each with a specialized focus:
Together, we're removing the barriers that keep people from receiving the kind of quality health care that makes a difference. We focus on Integrity, Compassion, Relationships, Innovation and Performance as we empower people to achieve better health and well-being.
Come grow and thrive in our culture of innovation and ideas. Because there is no opportunity greater than the quest to help people live healthier lives.
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
Diversity creates a healthier atmosphere: 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. In addition, employees in certain positions are subject to random drug testing.
Key words: RN, nurse, registered nurse, acute care, project, project management, account management, KS, Kansas
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