Senior Clinical Quality RN - Remote

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 to start Caring. Connecting. Growing together. There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Nursing here isn't for everybody. Instead of seeing a handful of patients each day, your work may affect millions for years to come. You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: Support the West Region and assists with oversight of delegation compliance for the West Region for all delegated health plans (Medicare Advantage, Medicaid, Commercial, and Special Needs Plans) Assist with audits for annual, semi-annual, and quarterly audits Partners with key internal and external stakeholders for remediation efforts, as applicable Support for all delegation reporting Assist with pre-delegation audits for new business Review and audit West Region contracted Sub-delegation/Vendors, as indicated Participates in or coordinates with other West Region department projects as needed Participates in and represents the West Region Clinical Quality Team by collaborating with internal business partners focusing on quality improvement 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 Qualification: Current, active, and unrestricted RN license 3+ years of clinical experience as an RN 1+ years of quality experience or equivalent experience 1+ years working in managed care or in the insurance industry Experience with Medicare, Commercial and/or Medicaid Knowledge base of NCQA and governing and regulatory agency requirements Ability to evaluate medical records with attention to detail to perform quality audits Preferred Qualifications: Experience with project coordination Experience with regular auditing or business monitoring Experience with Microsoft office software (including Excel & PowerPoint) Knowledge of Medical Dual (DSNP) and Medicaid environment Proficiency in software applications that include, but are not limited to, Microsoft Word, Microsoft Excel, Microsoft PowerPoint Subject matter expert for CMS Demonstrated ability to assist with focusing activities on a strategic direction as well as develop tactical plans, drive performance, and achieve targets Demonstrated ability to do formal presentations in different settings- internal/external auditors, reporting on projects and reports that have been created and analyzed Demonstrated sound organizational skills, self-motivated and ability to interact with company staff at all levels 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. Residents Only: The salary range for this role is $70,200 to $137,800 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: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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. OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.