Senior Clinical Quality of Care RN — Remote (AZ-based)

UnitedHealth Group; Arizona; Hybrid; USD 73,000 - 130,000; Full time

Job summary

UnitedHealth Group in Phoenix, AZ is seeking a Senior Clinical Quality of Care RN to conduct quality of care investigations, manage regulatory incident reporting, and ensure compliance with state and federal regulations for Arizona Medicaid and Medicare members. This full-time, day-shift role allows a remote-based arrangement with the option to work 40% in-office.

Up to 25% travel may be required as part of reviews and provider visits.

Qualifications

• Active, unrestricted RN license in Arizona.
• 5+ years of experience as a Registered Nurse.
• 2+ years of hospital RN experience.
• Experience evaluating and auditing medical records.
• Active RN license in Arizona and ability to travel locally.
• Driver's license and reliable transportation.
• Must reside within the state of Arizona.

Responsibilities

• Perform quality of care investigations for Medicaid and Medicare members.
• Conduct clinical documentation reviews of inpatient and outpatient care.
• Create professionally written case investigation summaries for Peer Review.
• Review plans of correction from providers in response to QOC occurrences.
• Interface with external customers, facilities, and providers to resolve quality of care concerns.
• Conduct delegated oversight reviews of contractors performing work on behalf of UnitedHealthcare.
• Collaborate with Medical Directors and staff in other departments.
• Manage multiple tasks and projects with changing priorities.
• Maintain timeliness for deliverables and regulatory requests.
• Occasional on-site provider visits for potential Quality of Care concerns.

Skills

RN experience

Clinical documentation

Regulatory auditing

Healthcare quality

Job description

UnitedHealth Group in Phoenix, AZ is seeking a Senior Clinical Quality of Care RN to conduct quality of care investigations, manage regulatory incident reporting, and ensure compliance with state and federal regulations for Arizona Medicaid and Medicare members. This full-time, day-shift role allows a remote-based arrangement with the option to work 40% in-office.

Up to 25% travel may be required as part of reviews and provider visits.