RN Clinical Quality for LTC Tucson

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) 

 Applying clinical knowledge and expertise to determine the degree to which an investigated occurrence increased the likelihood of adverse health outcomes, and determine if the actions taken by healthcare providers were consistent with current professional knowledge and guidelines.

 Create professionally written case summaries, for Peer Review, and create professionally written letters to regulatory agencies

 Presenting cases before a provider advisory committee in conjunction with the reviewing Medical Director.

 Reviewing plans of correction from providers in response to a substantiated QOC or CI occurrence.

 Taking actions to report CI or other applicable occurrences according to State and Federal guidelines and UnitedHealthcare policy and procedure. 

Effectively interface with internal and external customers, facilities and providers to resolve quality of care concerns, obtain medical records and information.

 Conducting 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.

 Performing on-site audits of residential care facilities such as assisted living facilities or practitioner offices.

 Assisting in the development of oversight tools and processes for clinical quality assessment.

 Manage Multiple tasks and projects and changing priorities; prioritize work products effectively

 Maintain timeliness for deliverable and Regulator requests

 Must have the ability to work independently, good critical thinking skills, excellent verbal and written communication skills,

Basic Requirements:

Active, unrestricted AZ RN license

Long Term Care experience of 2 plus years

Ability to travel 20% of time

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.