Clinical Practice Consultant Supervisor, RN - Pittsburgh, PA - Full-time / Part-time

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. This is the place to do your life's best work.(sm)
 
This position as the Clinical Consultant Supervisor, RN, consults with and guides practice on developing innovative solutions to practice organization and structural challenges in order to achieve desired program outcomes. Helps practice meet and exceed expectations/milestones for achieving success as an ACO/JOC.
 
Primary Responsibilities:

Directly supervises the Clinical Practice Consultants to ensure the program goals are met
Acts as a liaison to the Clinical Practice Consultants, health plan and providers as necessary
Coordinate and monitor implementation of quality improvement initiatives that are undertaken as corrective action for HEDIS results, clinical studies, or other quality measures
Coordinates and trouble shoots for issues pertaining to the member and/or provider incentive programs
Provides direct supervision to evaluate, track, and coordinate corrective action plans relating to improvement of coordination of care,  plan-wide provided by the QM nurses
Participate in or coordinate other department projects as needed
If required, supports state specific medical record collection and abstraction processes to drive optimum measurement and quality metric reporting during ambulatory medical record review, HEDIS data collection, or for other focus studies as directed by the QM Manager
Coordinates and performs onsite clinical evaluations through medical record audits to determine appropriate coding and billing practices, compliance with quality metrics, compliance with service delivery and quality standards
Perform/participate in assessments of the audit or review (e.g., interrater reliability of audit findings across auditors)
Perform duties as assigned

Required Qualifications:       

Current, unrestricted RN license for the state of residence
2+ years of clinical experience
2+ years of managerial/supervisory experience
3+ years of HEDIS experience
Computer proficiency, including Microsoft Word, Excel, Outlook
Preferred Qualifications:

Quality Management
Performance Improvement
Experience with NCQA
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
 
 
Job Keywords: RN, nurse, registered nurse, case manager, HEDIS, Pittsburgh, Pennsylvania, Quality Management, NCQA, Six Sigma, Performance Improvement, Medicaid, Medicare, United Health Care, UHC, Pittsburgh, PA