Sr. Clinical Quality Rn - Remote

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)

This role reports to Quality Leadership and is responsible for ongoing provider education related to HEDIS and pay for performance (P4P) measures, as well as state-mandated and accreditation-related quality requirements. The Sr. Clinical Quality RN will serve as a liaison to establish trusting relationships with MO C&S providers to problem-solve and provide resources to support improved member quality outcomes. This role will also support additional health plan initiatives such as medical record reviews, external quality audits, and clinical data integration.

If you are located in Kansas City, MO, you will have the flexibility to work remotely* as you take on some tough challenges. Onsite meetings with providers 1-3xs week.

Primary Responsibilities:

• Collaborating with internal health plan partners on clinical quality initiatives, such as those related to Performance Improvement Projects (PIPs), data integration efforts with providers, CAHPS, and NPS improvement
• Supporting health plan initiatives to maximize HEDIS rates and achieve P4P targets both prospectively and during the medical record chase process retrospectively
• Monitoring and reviewing Patient Care Opportunity Reports (PCOR) with providers to facilitate member preventative wellness and closure of care gaps
• Representing the health plan at community events when needed
• Representing the health plan in meetings with healthcare providers to promote health plan quality initiatives and Value-Based care programs, and to provide needed resources to support improved member quality outcomes
• Coordinating remote and onsite provider medical record reviews to assess compliance with documentation standards, service delivery, billing and coding practices, and quality standards

This role is responsible for approximately 25% travel within an assigned region.

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:

• Knowledge of one or more of the following: clinical standards of care OR preventive health standards, OR HEDIS, OR NCQA, OR regulatory requirements
• Current unrestricted RN licensure in Missouri
• 5+ years of clinical experience in any setting
• Able to travel up to 25% of the time to provider locations within a designated area, as well as other areas when needed to meet the needs of the team
• Must reside in Kansas City, MO area, surrounding county in state of Missouri, or the Missouri Western Region
• Intermediate proficiency in software applications that include, but are not limited to, Microsoft PowerPoint, Microsoft Word, Microsoft Excel, Microsoft Outlook, and Internet browsers
• Proven self-motivated and have ability to work well both independently and with others as a team
• Effective presentation skills and experience providing outcomes data to senior leadership
• Proven ability to develop provider relationships
• Proven ability to interact with internal and external customers in a professional manner
• 3+ years of quality experience (performance improvement, HEDIS performance measures, chart review, team facilitation, etc.)

Preferred Qualifications:

• Managed care experience
• Advanced proficiency in Excel (i.e., pivot charts, graphs, &/or data manipulation and analysis)
• Experience with Clinical Informatics
• Master’s degree
• Experience working with Medicaid and/or Medicare populations in a managed care setting
• Bilingual - English/Spanish
• Proficiency in software applications that support HEDIS activities, including but not limited to, Tableau, and vendor platforms

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.