UnitedHealth Group
Clinical Quality Analyst - National Remote
UnitedHealth Group, Phoenix, Arizona, United States, 85003
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 diversity and inclusion, talented peers, comprehensive benefits, and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.
The Clinical Quality Analyst completes independent, subjective assessments of member calls and cases in accordance with the Optum’s policies and external customer and regulatory standards. This will ensure adherence to departmental and regulatory data integrity standards and requirements including contractual obligations with State and Federal agencies and Center for Medicare & Medicaid Services (CMS).
This position is full time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work during our normal business hours of 8:00am - 5:00pm CST. It may be necessary, given the business need, to work occasional overtime.
We offer weeks of on-the-job training. The hours of the training will be 8am-5pm CST.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
Independently use discretion and judgment to evaluate subjective clinical documentation of member records and call engagements to assess performance of nursing skill.
Analyze current clinical quality processes and identify gaps to improve overall effectiveness.
Consults with Medical Directors to calibrate on subjective assessments to ensure consistency of feedback related to complex, high risk cases.
Assist’s Optum employees to stay ahead of changing information while improving the quality and effectiveness of nurse and consumer engagement.
The Clinical Quality Analyst will highlight key findings to share with Centralized Auditor Managers.
Ensure that process and procedural changes are reflected in staff member’s documentation such as job aids and policies.
Must stay abreast of all customers specific details, to ensure high quality customer service.
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 in Nursing
Current, unrestricted RN license
3+ years of clinical experience in a hospital, acute care, home health / hospice, direct care or case management
Working Knowledge of Medical Benefits
Experience with Microsoft Excel (ability to create, edit, copy, save, and send spreadsheets), Microsoft PowerPoint (ability to create, edit, copy, save, and send presentations), Microsoft Word (ability to create, edit, copy, save, and send documents) and Microsoft Outlook (ability to create, edit, copy, save, and send correspondence)
Ability to work full time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am - 5:00pm CST. It may be necessary, given the business need, to work occasional overtime
Preferred Qualifications:
Bachelor’s Degree
2+ years of clinical audit experience
Bilingual Fluency in English and Spanish
Telecommuting Requirements:
Ability to keep all company sensitive documents secure (if applicable)
Required to have a dedicated work area established that is separated from other living areas and provides information privacy
Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service
*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, Washington, Washington, D.C., Maryland Residents Only: The salary range for this role is $58,300 to $114,300 annually. 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.
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.
#RPO
The Clinical Quality Analyst completes independent, subjective assessments of member calls and cases in accordance with the Optum’s policies and external customer and regulatory standards. This will ensure adherence to departmental and regulatory data integrity standards and requirements including contractual obligations with State and Federal agencies and Center for Medicare & Medicaid Services (CMS).
This position is full time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work during our normal business hours of 8:00am - 5:00pm CST. It may be necessary, given the business need, to work occasional overtime.
We offer weeks of on-the-job training. The hours of the training will be 8am-5pm CST.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
Independently use discretion and judgment to evaluate subjective clinical documentation of member records and call engagements to assess performance of nursing skill.
Analyze current clinical quality processes and identify gaps to improve overall effectiveness.
Consults with Medical Directors to calibrate on subjective assessments to ensure consistency of feedback related to complex, high risk cases.
Assist’s Optum employees to stay ahead of changing information while improving the quality and effectiveness of nurse and consumer engagement.
The Clinical Quality Analyst will highlight key findings to share with Centralized Auditor Managers.
Ensure that process and procedural changes are reflected in staff member’s documentation such as job aids and policies.
Must stay abreast of all customers specific details, to ensure high quality customer service.
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 in Nursing
Current, unrestricted RN license
3+ years of clinical experience in a hospital, acute care, home health / hospice, direct care or case management
Working Knowledge of Medical Benefits
Experience with Microsoft Excel (ability to create, edit, copy, save, and send spreadsheets), Microsoft PowerPoint (ability to create, edit, copy, save, and send presentations), Microsoft Word (ability to create, edit, copy, save, and send documents) and Microsoft Outlook (ability to create, edit, copy, save, and send correspondence)
Ability to work full time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am - 5:00pm CST. It may be necessary, given the business need, to work occasional overtime
Preferred Qualifications:
Bachelor’s Degree
2+ years of clinical audit experience
Bilingual Fluency in English and Spanish
Telecommuting Requirements:
Ability to keep all company sensitive documents secure (if applicable)
Required to have a dedicated work area established that is separated from other living areas and provides information privacy
Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service
*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, Washington, Washington, D.C., Maryland Residents Only: The salary range for this role is $58,300 to $114,300 annually. 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.
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.
#RPO