QAPI Clinical Review RN

UnitedHealth Group; Las Vegas (NV); Hybrid; Confidential; Full time

Benefits offered by this job

Sign-on bonus

Hybrid work schedule

Comprehensive benefits package

Job summary

UnitedHealth Group in Nevada seeks a Clinical Review QAPI RN to support quality initiatives through comprehensive medical record review, OASIS data integrity, and ICD-10 coding accuracy across the network, with a hybrid schedule (3 days in office). You will collaborate with clinical staff and leadership to ensure regulatory compliance and improve patient care outcomes.

The role emphasizes implementing agency-wide QAPI programs, preparing reports, and educating physicians, nurses and staff on

Qualifications

• Current, unrestricted Nevada RN license, or temporary Nevada RN license with the ability to obtain permanent licensure upon expiration.
• BLS CPR certification.
• 3+ years of clinical RN experience, preferably in Home health.
• Medical record review and chart abstraction experience.
• Proven working knowledge of OASIS and ICD-10 coding.
• Knowledge of federal regulations and state licensure requirements.
• Excellent coordination and communication skills.
• Experience educating physicians, RNs, and other staff.
• Experience with EMR systems.
• Driver's license with reliable vehicle and valid insurance.
• Ability to work three days in office and two days at home.

Responsibilities

• Reviews all OASIS assessments for timeliness, completeness and compliance.
• Uses OASIS variation or alert reports during review.
• Ensures proper ICD-10 coding sequencing related to Admission summary.
• Consults with clinical staff to resolve data integrity issues and applies corrections.
• Notifies leadership of problematic trends from OASIS review.
• Collaborates with Clinical Leadership to address trends affecting outcomes.
• Participates in Quality Improvement and Corporate Compliance activities.
• Maintains knowledge by attending workshops and reading professional publications.
• Participates in Administrator on-call rotation.
• Assists in developing and implementing agency-wide QAPI programs via data collection and benchmarking.
• Prepares and presents QAPI reports to leadership.
• Serves as a resource for the EHR system and uses Agency technology to improve performance.
• Fosters a culture of clinical excellence with leadership; contributes to policies and surveys.
• Completes inter-rater reliability testing and training for consistent chart abstraction.
• Performs quality improvement audits and chart reviews.
• Educates physicians, nurses and staff on quality measures and documentation.
• Collaborates with internal quality team to drive performance improvement.

Skills

RN license

BLS CPR

Data integrity

OASIS knowledge

ICD-10 coding

EMR systems

Communication

Education of clinicians

Driver's license

Education

Bachelor's degree

COS-C certification preferred

Home Health ICD-10 coding certification

2+ years clinical quality experience

Tools

Electronic Medical Records (EMR)

Job description

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 to start Caring. Connecting. Growing together.

We are currently offering a $10,000 sign on bonus for external candidates!

The Clinical Review QAPI RN plays a critical role in supporting healthcare quality initiatives through comprehensive medical record review, analyzing data integrity and consistency of OASIS Documentation, ensuring appropriate ICD-10 dx sequencing and working with clinical staff to clarify documentation and data integrity issues. Under the direction of the QAPI RN Supervisor, develops and implements agency wide QAPI program focusing on assessment and improvement in clinical care and supporting processes and compliance with state and federal regulation. Working alongside an experienced team of clinical quality professionals, this individual will help ensure accurate and timely data collection, support compliance efforts, and contribute to improving care outcomes across the network. This role offers the opportunity to collaborate directly with providers, clinical teams, and healthcare organizations while making a meaningful impact on quality performance and patient care. This role will also have a hybrid schedule working 3 days in office.

Primary Responsibilities:

• Reviews all OASIS assessments to ensure timeliness, appropriateness, completeness and compliance with federal and state regulations
• Utilizes OASIS variation or alert reports when reviewing OASIS data
• Ensures appropriate ICD-10 coding sequencing as it relates to the Admission summary
• Consults with appropriate clinical staff to clarify any data integrity issues and works with clinician to make appropriate corrections
• Notifies agency leadership of problematic trends as a result of OASIS review
• Works with Clinical Leadership to address trends that affect the agency's outcome and process measure noted during OASIS review
• Participates in Quality Improvement and Corporate Compliance activities as assigned
• Maintains professional and technical knowledge by attending educational workshops and reviewing professional publications
• Participates in Administrator on-call rotation
• Assists in the development and implementation of an agency wide QAPI program via data collection, analysis, reporting, and benchmarking
• Prepares and presents reports regarding QAPI activities to agency leadership
• Serves as a resource for the electronic clinical information system; utilizes Southwest Medical Home Health ('Agency') technology resources to derive performance improvement
• In collaboration with Agency leadership, fosters a culture of clinical excellence via continuous assessment and quality of focus on performance improvement; acts as a resource to all levels of staff; participates in development of agency policies and processes; participates in and coordinates state and federal surveys to include corrective action plans and appropriate documentation to support Agency compliance with corrective action plans
• Complete inter-rater reliability testing and required training to support consistent and accurate medical record abstraction
• Perform quality improvement audits and chart reviews to identify and document required clinical information
• Provide education and guidance to physicians, nurses, and other clinical and non-clinical staff on quality measures, documentation practices, and related initiatives
• Collaborate with internal quality team members to drive performance improvement efforts and maintain data integrity

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• Current, unrestricted Nevada RN license, or temporary Nevada RN license with the ability to obtain permanent licensure upon expiration
• BLS CPR certification
• 3+ years of clinical RN experience, preferrable in Home health setting
• Medical record review and chart abstraction experience
• Proven working knowledge of OASIS and ICD 10 coding
• Proven knowledge of federal regulations and state licensure requirements
• Proven excellent coordination and communication skills
• Experience educating physicians, registered nurses, and/or clinical and non-clinical staff
• Experience working with Electronic Medical Records (EMR) systems
• Driver's License with automobile in good working order and maintain personal auto insurance coverage in accordance with organization requirements
• Ability to work three days in office and two days at home

Preferred Qualifications:

• Bachelor's degree
• Oasis Certification (COS-C) preferred. Home Health ICD-10 coding certification
• 2+ years of clinical quality experience, preferably in Home health
• HEDIS data collection experience
• Experience conducting medical record audits and documenting clinical information to support quality and compliance requirements
• Knowledge of healthcare quality improvement methodologies and regulatory standards

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $72,800 to $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

OptumCare is a drug‑free workplace. Candidates are required to pass a drug test before beginning employment.