Field Senior Clinical Quality RN - Kansas City, KS and Surrounding Counties
Company: UnitedHealthcare
Location: Kansas City
Posted on: October 11, 2024
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Job Description:
At UnitedHealthcare, we're simplifying the health care
experience, creating healthier communities and removing barriers to
quality care. The work you do here impacts the lives of millions of
people for the better. Come build the health care system of
tomorrow, making it more responsive, affordable, and equitable.
Ready to make a difference? Join us to start -Caring. Connecting.
Growing together. -
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The Senior Clinical Quality RN will focus on tasks that occur in
accordance with State, CMS or other requirements as applicable.
This position will also be responsible for direction and guidance
on provider-focused, clinical quality improvement and management
programs.
This role assists contracted providers with analyzing member care,
trending quality compliance at the provider level, and developing
action plans and programs to support provider practices in
continuous quality improvement using approved clinical practice
guidelines, HEDIS, CMS, NCQA and other tools. Position reports to
the Quality Leadership of the Health Plan.
This is a home-based office position with field responsibilities up
to 75% of the time. Travel to counties of Cherokee, Crawford,
Bourbon, Linn, Miami, Johnson, Wyandotte, Douglas, Franklin,
Anderson, Allen, Neosho, Labette, Montgomery, Wilson, Woodson,
Coffey, Osage, Greenwood, Elk, and Chautauqua, KS based on business
needs.
If you are located within Kansas City, KS or surrounding counties
you will have the flexibility to telecommute* as you take on some
tough challenges.
Primary Responsibilities:
Supports effective deployment of program at the practice level
through strategic partnerships with participating practitioners and
practice staff while assessing trends in quality measures and
identifying opportunities for quality improvement
Serves as subject matter expert (SME) for assigned HEDIS / State
Measures, preventive health topics, leads efforts with clinical
team to research and design educational materials for use in
practitioner offices; serves as liaison with key vendors supporting
HEDIS / State Measures; consults with vendors to design and
implement initiatives to innovate and then improve HEDIS / State
Measure rates
Participates, coordinates, and/or represents the Health Plan at
community-based organization events, clinic days, health department
meetings, and other outreach events focused on quality improvement,
member health education and disparity programs as assigned
Coordinates and performs onsite clinical evaluations through
medical record audits to determine appropriate coding and billing
practices, compliance with quality metrics, compliance with service
delivery and quality standards
Investigates gaps in clinical documentation where system variation
has impact on rate calculation, provides feedback to appropriate
team members where issues are verified, and monitors resolution to
conclusion
Works with providers on standards of care, and advises providers on
established clinical practice guidelines, and appropriate
documentation and billing consistent with state specific measures
and technical specifications
What are the reasons to consider working for UnitedHealth Group? -
Put it all together - competitive base pay, a full and
comprehensive benefit program, performance rewards, and a
management team who demonstrates their commitment to your success.
Some of our offerings include:
Paid Time Off which you start to accrue with your first pay period
plus 8 Paid Holidays
Medical Plan options along with participation in a Health Spending
Account or a Health Saving account
Dental, Vision, Life& AD&D Insurance along with Short-term
disability and Long-Term Disability coverage
401(k) Savings Plan, Employee Stock Purchase Plan
Education Reimbursement
Employee Discounts
Employee Assistance Program
Employee Referral Bonus Program
Voluntary Benefits (pet insurance, legal insurance, LTC Insurance,
etc.)
More information can be downloaded at: -
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:
Current unrestricted RN licensure in state of Kansas
2+ years clinical experience as an RN
2+ years of experience with quality improvement
Intermediate level of proficiency in MS Office including Word,
Excel, Outlook
Current, non-restricted state of Kansas driver's license and
state-required insurance
Access to reliable transportation and the ability to travel up to
75% of the time -to providers
Access to a designated quiet workspace in your home (separated from
non-workspace areas) with the ability to secure Protected Health
Information (PHI)
Live in a location that can receive a UnitedHealth Group approved
high-speed internet connection or leverage an existing high-speed
internet service
Preferred Qualifications:
BSN, Master's Degree (or higher) in Clinical Field -
HEDIS; NCQA experience
Experience leading teams or individuals for better quality
outcomes
Health care and insurance industry experience, including regulatory
and compliance
Background in Managed Care -
*All Telecommuters will be required to adhere to UnitedHealth
Group's Telecommuter Policy.
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.
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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.
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UnitedHealth Group -is a drug - free workplace. Candidates are
required to pass a drug test before beginning employment.
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#RPO #Red
Keywords: UnitedHealthcare, Saint Joseph , Field Senior Clinical Quality RN - Kansas City, KS and Surrounding Counties, Healthcare , Kansas City, Missouri
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