RN Clinical Quality Analyst

Optum; Worcester (MA); Hybrid; USD 60,000 - 107,000; Full time

Job summary

Reliant Medical Group, part of the Optum family, is seeking an RN Clinical Quality Analyst to participate in peer reviews, assess quality of care, and support performance improvement in a hybrid Worcester, MA setting. You will review case records, apply policies, and communicate findings to clinicians while collaborating with Risk & Quality Management to address system issues and ensure compliance.

This role requires Massachusetts RN licensure, 5+ years nursing experience, EMR familiarity, and

Qualifications

• Graduate from an accredited school of Nursing and current licensure as a Registered Nurse in Massachusetts.
• 5+ years nursing experience in a healthcare setting including hospital medical/surgical or ambulatory care.
• Experience utilizing electronic medical records.
• Knowledge of various software applications such as Microsoft PowerPoint, Excel, Access, Outlook.

Responsibilities

• Participates in the Peer Review Program by performing quality case reviews submitted by risk management, incident reports, audits, sentinel events, clinician referrals or any complaints related to quality of care.
• Utilizes critical thinking skills when interpreting and incorporating the organization’s policies and procedures to assess and evaluate case medical records, including chart review, provider feedback, and any previous reviews completed on the case to identify and address potential individual provider or operational process issues which impact the quality of care delivered at Reliant.
• Utilizes critical thinking skills to determine appropriate patient outcome and care ratings based on review findings and communicate the conclusions to providers.
• Participates with the development and correction of organizational system issue fixes to ensure compliance with legal and other external regulations/requirements to support the continuous performance improvement of the quality of care and service provided by the organization.

Skills

Critical thinking

Quality improvement

Provider feedback

Education

Massachusetts RN Licensure

Tools

Microsoft PowerPoint

Microsoft Excel

Microsoft Access

Microsoft Outlook

Job description

Improve the lives of others while Caring. Connecting. Growing together.

Job Description - RN Clinical Quality Analyst (2379688)

RN Clinical Quality Analyst - 2379688

Opportunities with Reliant Medical Group, part of the Optum family of businesses. Join a community-based, multi-specialty, physician-led organization where you will work with talented peers on a common purpose: improving the quality, cost and experience of health care. Here, we focus on delivering the best patient care, rather than volume. Through innovation and superior care management, we support patients and your well-being as a team member. Join a team at the forefront of value-based care and discover the meaning behind Caring. Connecting. Growing together.

Position Details:

• Location: 385 Grove Street, Worcester MA
• Department: Risk & Quality Management

Hybrid environment - must be able to report to the physical office as needed

Primary Responsibilities:

• Participates in the Peer Review Program by performing quality case reviews submitted by risk management, incident reports, audits, sentinel events, clinician referrals or any complaints related to quality of care
• Utilizes critical thinking skills when interpreting and incorporating the organization’s policies and procedures to assess and evaluate case medical records, including chart review, provider feedback, and any previous reviews completed on the case to identify and address potential individual provider or operational process issues which impact the quality of care delivered at Reliant
• Utilizes critical thinking skills to determine appropriate patient outcome and care ratings based on review findings and communicate the conclusions to providers
• Participates with the development and correction of organizational system issue fixes to ensure compliance with legal and other external regulations/requirements to support the continuous performance improvement of the quality of care and service provided by the organization

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:

• Graduate from an accredited school of Nursing and current licensure as a Registered Nurse in Massachusetts
• 5+ years nursing experience in a healthcare setting including hospital medical/surgical or ambulatory care
• Experience utilizing electronic medical records
• Knowledge of various software applications such as Microsoft PowerPoint, Excel, Access, Outlook, etc.

Preferred Qualification:

• Demonstrated experience in database management, statistical analysis, and graphics software

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 $60,200 - $107,400 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.

UnitedHealth Group 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

UnitedHealth Group is committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities. If you need special assistance or accommodation for any part of the application process, please call 1-866-566-8715 to be connected to Recruitment Services. Recruitment Services hours of operation are 7 a.m. to 7 p.m. CT, Monday through Friday.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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.