Quality Improvement Manager - Remote

Lensa; El Segundo (CA); Remote; USD 89,000 - 177,000; Full time

Job summary

A leading healthcare organization in El Segundo is seeking a Quality Improvement Manager to oversee clinical operations and improve healthcare quality. The role involves managing clinical staff, monitoring grievances, and ensuring compliance. Candidates should have a nursing background and experience in health plan services.

Benefits

Comprehensive benefits package

Incentives

Equity options

401k contributions

Qualifications

• Minimum of 2 years' experience in Appeals and Grievances.
• 2+ years of supervisory or team coordination experience.

Responsibilities

• Monitor grievance database activity and ensure timely investigation.
• Facilitate team meetings and case reviews.
• Implement quality assurance measures.

Skills

Leadership

Problem Solving

Communication

Education

Graduation from an accredited nursing school

Tools

Excel

Job description

2 days ago Be among the first 25 applicants

Lensa is the leading career site for job seekers at every stage of their career. Our client, UnitedHealth Group, is seeking professionals. Apply via Lensa today!

Optum CA is seeking a Quality Improvement Manager to join our team in El Segundo, CA. Optum is a clinician-led care organization that is changing the way clinicians work and live.

As a member of the Optum Care Delivery team, you’ll be an integral part of our vision to make healthcare better for everyone.

At Optum, you’ll have the clinical resources, data, and support of a global organization behind you to help your patients live healthier lives. Here, you’ll work alongside talented peers in a collaborative environment that values diversity and inclusion while striving for the Quadruple Aim. We believe you deserve an exceptional career and will empower you to live your best life at work and at home. Experience the fulfillment of improving community health while contributing innovative practice ideas that can enhance care for millions nationwide. Together, we can make healthcare better for everyone. Join us and discover how rewarding medicine can be—

Caring. Connecting. Growing together.

This position manages the daily operations of clinical staff (QI Nurses) within the Grievance/Peer Review Lane of the Optum CA Quality Improvement Department. Reporting directly to the Senior Director of Quality Improvement, the role collaborates with the QI Ops Manager and clinical staff to oversee case productivity, turnaround times, and quality in handling health plan grievances and potential quality issues. Additional information can be provided upon request.

If you are RN or LVN licensed in California, you will have the flexibility to work remotely* while tackling meaningful challenges.

Primary Responsibilities

• Monitor grievance database activity, ensuring timely investigation of potential quality issues
• Generate and review trend reports by provider, issue, and severity level
• Facilitate team meetings and case reviews to monitor productivity and support continuous improvement
• Identify Quality of Care PQIs for investigation and coding through the PRC process
• Implement quality assurance measures, including chart audits, to assess documentation and case review quality
• Coordinate Peer Review Committee activities as designated by the PR Chair
• Maintain PRC minutes with attention to regulatory compliance
• Work with the Sr Director to identify outside MD reviewers for cases as needed
• Annually select cases for IRR and report findings to PRC and QI Committee

We offer a rewarding environment that challenges and guides you toward success, with opportunities for professional development and growth.

Required Qualifications

• Graduation from an accredited nursing school
• Active RN or LVN license in California
• Minimum of 2 years' experience in Appeals and Grievances, Claims, or Health Plan Customer Service
• At least 2 years managing work inventory to meet compliance metrics
• 2+ years of supervisory or team coordination experience

Preferred Qualifications

• Experience developing workflows and transitioning to new systems, such as grievance databases
• Background in Case Management, Inpatient, or Ambulatory care
• Knowledge of health plan turnaround times and performance metrics
• Ability to learn and implement new systems and technologies
• Proficiency in Excel and relevant databases/software
• Skilled in optimizing workflows to improve team productivity

The salary range is $89,800 to $176,700 annually, based on full-time employment, experience, and other factors. Benefits include comprehensive packages, incentives, equity options, and 401k contributions. All employees must adhere to UnitedHealth Group’s Telecommuter Policy. This is an equal opportunity employer and a drug-free workplace, requiring a pre-employment drug test.