Senior Clinical Quality RN - Remote (Arizona)

UnitedHealthcare; Phoenix (AZ); Hybrid; USD 73,000 - 130,000; Full time

Job summary

UnitedHealthcare is seeking a Senior Clinical Quality of Care RN in Arizona to conduct quality of care investigations and manage regulatory IAD processes. The role collaborates with Medical Directors to ensure compliance with state, federal and professional standards.

It is a remote Arizona-based position with up to 25% travel and 40% in-office optional. You must have an active AZ RN license, 5+ years of RN experience, and experience auditing medical records.

Qualifications

• Active, unrestricted RN license in Arizona.
• 5+ years of RN experience.
• 2+ years in hospital RN role.
• Experience evaluating and auditing medical records.
• Proficient in MS Office (Word/Excel).
• Ability to travel up to 25% within Arizona.

Responsibilities

• Perform clinical documentation reviews of inpatient and outpatient care for Medicaid/Medicare members.
• Prepare case investigation summaries for Peer Review and Provider Advisory Committee.
• Review plans of correction from providers after QOC substantiations.
• Interface with facilities, providers and external customers to obtain records and information.
• Oversee delegated contractor oversight reviews and audits.

Skills

Clinical documentation review

Regulatory compliance knowledge

Critical thinking

Verbal and written communication

Travel readiness

Education

RN license (Arizona)

Tools

Microsoft Office

Excel

Word

Job description

UnitedHealthcare is seeking a Senior Clinical Quality of Care RN in Arizona to conduct quality of care investigations and manage regulatory IAD processes. The role collaborates with Medical Directors to ensure compliance with state, federal and professional standards.

It is a remote Arizona-based position with up to 25% travel and 40% in-office optional. You must have an active AZ RN license, 5+ years of RN experience, and experience auditing medical records.