Clinical Quality RN – Remote

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.  

The Clinical Quality RN is a subject matter expert for Primary Source Verification and Supplemental Data Entry. They assist with the coordination of HEDIS® and STARs data gathering within Pathway, Ubiquity, XLCare, eHouseCalls, and other applications as needed.  This role evaluates the quality and completeness of clinical documentation, by performing quality medical record reviews, assisting in the improvement of the clinical documentation process, maintaining accurate records of review activities, ensuring all data submitted to the health plan meets the HEDIS®/Star technical specifications for medical records. This role supports end of year final push activities, as well as hybrid chart chase processes.

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Review and abstract medical record data into appropriate application(s)
• Support chart chase processes by requesting/obtaining records as needed
• Primary source verify abstracted medical record data
• Over read abstracted and verified medical record data
• Analyze chart data, evaluate for possible data integrity and/or data deficits and document findings
• Provide education and feedback to primary source verifiers and/or abstractors
• Support chart chase processes by requesting records from provider offices as needed
• Navigate multiple documentation systems and obtain medical record sections supportive of HEDIS/Star measures
• Support and improve communications between market and corporate departments
• Support member outreach campaigns within the HAO organization, as needed
• Maintain education/knowledge base of HEDIS®/STARs standards and guidelines
• Assist with process improvement
• Performs all other related duties as assigned

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:

• Associate degree
• Registered Nurse
• 3+ years of experience with data analysis/quality chart reviews. Must be able to review data and provide recommendations for improvement
• 2+ years HEDIS Abstraction/STAR experience
• 2+ years Overread experience
• Experience using Microsoft office applications, including databases, word-processing, and Excel® spreadsheets
• Proven excellent communication practices, both oral and written

Preferred Qualifications:

• Undergraduate degree
• Certified Professional Coder
• 1+ years of process improvement experience
• Experience in training and excellent presentation skills
• Proven ability to be flexible in a continuously changing environment

Physical & Mental Requirements:

• Ability to lift up to 25 pounds
• Ability to sit for extended periods of time
• Ability to use fine motor skills to operate office equipment and/or machinery
• Ability to receive and comprehend instructions verbally and/or in writing
• Ability to use logical reasoning for simple and complex problem solving

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

The hourly range for this role is $23.70 to $46.35 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. 

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