Sr Clinical Quality Nurse Rn - Remote In Nebraska

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 and start doing your life's best work.(sm)

If you are located in Nebraska, you will have the flexibility to work remotely*, as well as work in the Omaha office as you take on some tough challenges.

Primary Responsibilities:

• This process includes reviewing chart chase educational materials, documenting in rateLIFT and OnBase, updating spreadsheets, calling provider offices, faxing chart chase requests, and attending weekly QOI meetings and vendor meetings to receive updates on rates
• Send monthly emails to providers notifying them that their latest PCOR is available to view and manage in Practice Assist
• Communicate frequently with the UHC Networking team to gather provider contact information from newly signed CP-PCPi agreements
• Review and monitor measures that are on the report with providers to assist in meeting quality standards, state contractual requirements, and performance incentives
• Participate in HEDIS Chart Chase operations, which includes provider outreaches in order to obtain the necessary medical records
• Developed provider education on the PPC and WCC measures in hopes to have better compliance in the future
• Provider education regarding the quality improvement program, which involves reviewing HEDIS measures and gaps in care on the Patient Care Opportunity Report (PCOR)
• Educate and support providers on the use of Practice Assist, which is a convenient tool that shares information with providers about their patients who are UHC members. This platform uses claim, lab, and pharmacy data to communicate which members have medical conditions for providers to evaluate
• Troubleshoot, submit, and review ServiceNow tickets for technical issues within Practice Assist
• Document all provider interactions and communications in IMPACT
• Ongoing management of provider education on quality HEDIS measures
• May lead or is instrumental in the following meetings: HQUM, ER PIP work group, Meetings with HSD and MD on high profile cases; UNMC, HRCM meetings, Top 5% member management, weekly MDR, Member Interdisciplinary conferences for KB and PDN members, participates in P&P meetings, involved in monthly mandatory state restrictive services conference calls
• Support providers who have signed a CP-PCPi agreement so that they can earn bonuses for helping UHC members become more engaged in their preventative healthcare needs
• Prepares Health Services state reports, quarterly and ad hoc, including data analysis
• Lead efforts with clinical teams to provide educational materials on preventative health and chronic disease management to help implement initiatives to improve HEDIS quality measures and rates
• Educate providers on HEDIS quality measures that are reported as administrative or hybrid and how the data is collected and reported by possible billing codes and/or supplemental data
• Maintains and builds relationships with all aspects of UHC such as: Interaction with Optum Services, BI, Appeals and Grievances, Compliance, Providers, Hospitals, Vendors and Members
• Provision new providers in PUMA to grant them access to Practice Assist
• Participates in EQRO and NCQA Audits (NCQA measures QI 7,8,9,10)
• Participates in the following work groups: Appeals and Grievances, Provider Satisfaction, Provider admin guide revamp, Lead Members, Sickle Cell Disease, CHF
• May complete monthly chart audits on HRCM cases
• Educate and support providers on the UHC PATH Reference Guide, which provides quality measure information specific to UHC members who are due to get preventative care and chronic disease management. This resource can help providers better understand the specifications for quality measures. They will see the tools used to address care opportunities, as well as how to report data and possible codes to use for billing
• Additional duties as needed by Director or Associate Director of Medical Clinical Operations and/or Quality
• Develop and continue provider-oriented partnerships in order to increase quality compliance to approximately 180 provider groups

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:

• Active, unrestricted RN license in the state of residence
• Intermediate to Advanced computer proficiency in Microsoft Word, Excel, Outlook, PowerPoint and Internet
• Willing or ability to travel up to 25%
• 3+ years of clinical nursing experience
• Reside in state of Nebraska
• Experience with presenting presentations and public speaking

Preferred Qualifications:

• Data Analysis experience
• Knowledge of Nebraska Administrative Code (NAC Manual)
• Experience with quality improvement initiatives
• Program development experience
• Utilization Review background
• Experience interfacing with Regulatory and State Govt. Officials
• 5+ years RN experience in performing UM, CM responsibilities working with the Medicaid population
• Demonstrated leadership capabilities

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)

• All employees working remotely 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.

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.