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UnitedHealth Group RN Clinical Quality Analyst - Phoenix, AZ in Phoenix, Arizona

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm)

The RN Clinical Quality Analyst will be responsible for conducting quality of care (QOC) investigation, review and management of the regulatory Incident/Accident/Death (AD) portal, documenting and communicating findings from these reviews, and preparing reports or summaries for internal and external customers. This position collaborates with the Chief Medical Officer or other Medical Directors to review QOC and other investigations, and ensures that QOC investigations comply with all applicable State, Federal, and regulatory requirements. These activities are used to ensure care and services provided to our members are timely, adequate, and compliant with regulatory and professional standards and guidelines.

This is an office-based position located at 1 East Washington Street in Phoenix with the potential to work from home 1-2 days per week after initial orientation and training based on business needs.

Primary Responsibilities:

  • Perform clinical documentation review of inpatient and outpatient care delivered to adults and children with Medicaid, Medicare health care benefits through Arizona United Health Care Community Plans for peer review and internal investigations of Quality of Care concerns

  • Create professionally written case investigation summaries for Peer Review, present case summaries at the Provider Advisory Committee as applicable

  • Review plans of correction from providers in response to a substantiated QOC occurrence

  • Effectively interface with external customers, facilities and providers to resolve quality of care concerns, obtain medical records and other information

  • Conduct delegated oversight reviews of contractors that perform work on behalf of UnitedHealthcare. This includes reviewing samples of contractor work against an audit tool or information found in medical charts

  • Collaborate internally with Medical Directors and staff in other UHCCP departments

  • Manage multiple tasks and projects and changing priorities; prioritize work products effectively

  • Maintain timeliness for deliverables and regulator requests

  • Must have the ability to work independently, good critical thinking skills, excellent verbal and written communication skills

Required Qualifications:

  • Active, unrestricted RN license in the state of Arizona

  • 5 + years of experience working as a Registered Nurse

  • 1 + years of hospital experience as a Registered Nurse

  • Experience evaluating and auditing medical records

  • Intermediate skills in Microsoft Office, Word, and Excel ability to work with multiple data bases to retrieve and enter information

Preferred Qualifications:

  • Experience with Pediatric population

  • Experience with Intellectually and/or Developmentally Disabled populations

  • Knowledge of Medicare/Medicaid regulations

  • Quality Management experience in a healthcare setting

  • Experience analyzing information and preparing written summaries

  • Experience working in a deadline driven environment prioritizing responsibilities

Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV / AIDS and high - risk pregnancy. Our holistic, outcomes - based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.(sm)

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.

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

Keywords: Quality RN, Registered Nurse, RN, quality of care, QOC, CPC, clinical practice consultant, audit, Medicare, Medicaid, , healthcare, managed care, Phoenix, AZ, Arizona