Senior Clinical Quality RN - South Maryland / Washington DC area - Telecommute - Full-time / Part-time

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)
 
Must live in South Maryland / Washington DC region.
 
Primary Responsibilities:

Position is responsible for analysis and review of quality outcomes at the provider level, provider education on quality programs, monitoring and reporting on key measures to ensure providers meet quality standards and implementation of pay for performance initiatives
Position conducts audits which occur in accordance with State, CMS or quality related requirements
Responsible for the reporting and analysis of provider member care quality compliance
The following further defines what is considered to be in scope with position:

Chart review in provider offices for coding validation to ensure documentation encompasses totality of member's conditions
Education of provider and office staff regarding billing and encounter submission in accordance with health plan regulatory requirements
Chart review in provider offices for compliance with applicable Quality / HEDIS / NCQA / State initiatives
Education of provider and office staff on HEDIS / NCQA / State specifications and how to meet those requirements
Support of plan and regulatory - required quality initiatives
Hybrid Medical Record retrieval as necessary
Education of provider and office staff on HEDIS specifications, state regulatory requirements related to quality, etc.
Document the presence of information that conforms to accepted standards of medical practice, which includes evidence of continuity and coordination of care
Evaluate compliance with medical record HEDIS, NCQA and State requirements

Required Qualifications:
 

Bachelor of Science in Nursing
Current, unrestricted RN licensure
Computer savvy with strong computer skills to include Word, Excel, Outlook
Preferred Qualifications:

HEDIS / NCQA experience
Medicaid / Medicare experience
 
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: quality improvement nurse, HEDIS, NCQA, RN, registered nurse, medicaid, medicare, Maryland, MD, Washington DC, telecommute, telecommuting, telecommuter, remote