Clinical Quality RN - 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)
 
Are you looking for an innovative and challenging position to be key in the Quality oversight of our providers and vendors? Use your clinical, analytical and quality skills to ultimately validate that quality of care is being provided to our patient population.

Optumcare  is a network of health care providers in the Southwest, whose mission is to connect and support providers by working together to deliver the most effective and compassionate care to each and every patient they serve.  Optum Medical Network’s focus is to do the right things for patients, physicians, and the community. Optum Medical Network’s Core Business is contracting directly with health insurers to deliver a highly personal care management and service model to their patients.  The current focus of Optum Medical Network is on seniors, and those with complex care needs, who most benefit from a high touch model of care.
 
If you want more meaning in your career - as a clinician or a business professional - think of OptumCare as your calling.
 
 
Primary Responsibilities:


Positions in this function are responsible for direction and guidance on clinical quality improvement and management programs including accreditation

Conducts clinical quality audits (CMS Regulations, State Regulations, File and Chart reviews, etc.) and may also be responsible for NCQA, URAC and Joint Commission audit requirements

Responsible for the reporting and analysis of member care quality and for the development of plans and programs to support continuous quality improvement using Microsoft Office Suite or Access

Analyzes and investigates

Provides explanations and interpretations within area of expertise

Responsible for Policy and Procedure Quality and Review

Training on and presenting new processes
Attend, participate and present at Committees as required
Project leader for Network Management and working with Physician Offices
Experience with Medicare/Medicaid, ACO, Stars and HEDIS
Ability to Multitask
 

Required Qualifications:


Bachelor’s degree or equivalent experience

RN license in AZ

3 years of experience in a clinical setting

3 years of QA experience

MS Office advanced proficiency is a must

Ability to travel to providers in Maricopa County and trips outside of Maricopa County as required - 20% to conduct audits and review charts, etc

Strong background in Quality Improvement / Management

Strong written and verbal communications
Preferred Qualifications:


BSN

Certifications in Quality Improvement / Management (Greenbelt, Lean, etc

CTQ

Clinical Database
Careers with OptumCare. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. OptumCare, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. OptumCare, incredible ideas in one incredible company and a singular opportunity 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: Registered Nurse, RN, Clinical, Phoenix, AZ, Arizona
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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