Senior Clinical Quality RN
Location: California
Description: UnitedHealth Group is currently interviewing Senior Clinical Quality RN right now, this occupation will be placed in California. More details about this occupation opportunity please read the description below. Clinical Quality! Telecommuting!
UnitedHealthcare has an immediate need for a Senior Clinical Quality RN to be responsible for the completion of effective, on-going quality improve! ment audits for both new and established MCR (medical claim review) clinical staff. This employee works under deadlines for audit completion, developing new audits and maintains established audits based on internal Policies and Procedures (P&Ps), Standard Operation Procedures (SOP's) and regulatory requirements (CMS, NCQA). The chosen candidate must demonstrate analytical thinking when it comes to audit results, ability to identify trends and areas of opportunity. This individual is responsible for working collaboratively with peers and the MCR management team to identify quality improvement opportunities, root causes and corrective actions.
*** This is aTelecommuting position that can be done from any region of the US!***
Job Components:
Refine MCR Clinical Staff quality auditing procedures.
Provide constructive auditing feedback to the MCR Clinical staff.
Partner with the MCR Management Team to provide effective and efficient! recommendations.
Promote and support MCR business ob! jectives..
Interface with Medical Directors, Management and nurses.
Contribute to or lead as needed, quality improvement projects
Requirements
Qualifications:
RN Licensure is required in the state of your residence
Minimum 5 years clinical nursing experience required
Strong computer skills and MS Office proficiency (i.e. Word and Excel)
Must be able to navigate around multiple systems and databases
Strong organizational skills
Strong communication skills, written and verbal
Ability to deliver constructive feedback
Must be able to work independently and demonstrate initiative
Must be able to meet strict deadlines
Desired Assets:
Managed Care experience
Clinical review/auditing experience (i.e. reviewing medical records for medical necessity using Milliman guidelines)
Familiar with Medicare and CMS regulations
BS! N
UnitedHealthcare , part of the UnitedHealth Group family of companies, is comprised of three specialized businesses dedicated to meeting the health care benefits needs of individuals and groups; all part of something greater, but each with a specialized focus:
UnitedHealthcare Employer & Individual works with individuals, small businesses and large multi-site employers to provide innovative, affordable benefits services.
UnitedHealthcare Medicare & Retirement is focused on serving Americans over the age of 50. It is the largest business dedicated to meeting the growing health and well-being needs of aging individuals in the nation, serving one in five Medicare beneficiaries through a comprehensive and diversified array of products and services through four industry-leading businesses.
UnitedHealthcare Community & State provides high-quality, personalized, public-sector health care programs that help local government agencies improve hea! lth outcomes for millions of children and low-income and disabled indivi! duals at an affordable cost.
Together, we're removing the barriers that keep people from receiving the kind of quality health care that makes a difference. We focus on Integrity, Compassion, Relationships, Innovation and Performance as we empower people to achieve better health and well-being.
Come grow and thrive in our culture of innovation and ideas. Because there is no opportunity greater than the quest to help people live healthier lives.
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
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If you were eligible to this occupation, please email us your resume, with salary requirements and a resume to UnitedHealth Group.
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This occupation starts available on: Sat, 30 Mar 2013 16:41:25 GMT