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Sr Clinical Quality RN - SNP Monitoring - Telecommute

Company: UnitedHealth Group
Location: Minnetonka
Posted on: May 9, 2022

Job Description:

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. Ready for a new path? Start doing your life's best work.(sm)The Clinical Program Performance (CPP) Senior Clinical Quality RN (SCQRN) will work with the management team to support monitoring in the department. - Business monitoring in the department includes: - UnitedHealthcare (UHC) Medicare and UHC Medicare Dual coverage plans and other audits as requested in accordance to Centers for Medicare & Medicaid Services (CMS) regulations and UHC Legal, Compliance & Regulatory Affairs (LCRA) policies and procedures. - The management team will prioritize the monitoring for each SCQRN based on Department responsibilities and SCQRN's training. Monitoring includes but is not limited to utilizing a validated universe and monitoring files. In addition, being knowledgeable about operational policies and procedures that relate to each is a business monitoring must for the SCQRN. - The SCQRN may participates in business monitoring meetings, mock audits and remediation discussions pre and post audit. - - - - - Primary Responsibilities:

  • The SCQRN will participate in all monitoring/auditing activities, including participation in meetings, utilization of requested monitoring tools, and active participation in the monitoring/auditing meetings
  • The SCQRN will be required to understand the source of truth for each monitoring/audit type and provide feedback and documentation based on the identified source of truth
  • Monitoring/audit will be prescriptive based on the area of focus with accuracy, data completeness, validity and reliability being a cornerstone for each type of monitoring/audit
  • Demonstrate a clear understanding of UHC Employer & Individual (E&I, Medicare & Retirement (M&R), and Community & State (C&S), NCQA end-to-end processes in coordination with Intake, Pre-Service, Utilization Management, Appeals, and Optum Disease and Case Management
  • Coordination and collaboration with other departments within UHC, UHG and Optum as indicated
  • Ability to work in a virtual environment, planning, organizing, and prioritizing the workload
  • Prepare and present audit files in accordance with the client's request, regulatory agency or Model of Care monitoring processes. -
  • Prepare and present audit files in accordance with the client's request, regulatory agency or Model of Care monitoring processes
  • For all monitoring events, participation in meetings, utilization of requested monitoring tools, and active participation in the monitoring meetings are required.
  • Some - monitoring may require a written overview of the monitoring - findings - that will be completed by the clinical consultant in conjunction with the Director or Program Owner - for the audit team
  • Act as a professional, knowledgeable representative of the Business Standardization - & Advancement (BSA) / UnitedHealthcare (UHC )Clinical Team effectively managing feedback
  • Act as a professional, knowledgeable representative of the UHC team effectively managing feedback.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:
    • Current RN license
    • 5+ Years of Clinical experience
    • A proven track record of expertise as an ICM or a Senior ICM in Enterprise Clinical Services (ECS) or experience as a Case Manager, or Senior Case Manager
    • Demonstrated organizational and time management skills with a strong ability to prioritize, problem solve and meet deadlines
    • Demonstrated expertise in UCS clinical operations and processes and an ability to clearly explain them
    • Proven computer skills in the Microsoft Office 365 suite of products (e.g.: Excel, PowerPoint, Word, Outlook)
    • Proven presentation skills, along with excellent verbal and written communication skills -
    • Proven presentation skills including Teams, along with excellent verbal and written communication skillsPreferred Qualifications:
      • Disease Management experience
      • Experience and expertise utilizing I-CUE and or CareOne, experience with other UHC systems
      • SNP experience
      • Demonstrated expertise in UCS clinical operations and processes and an ability to explain them clearlyTo protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employmentCareers with UnitedHealthcare. -Let's talk about opportunity. Start with a Fortune 10 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans wherever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do -your life's best work.(sm)*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy. Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $66,100 to $118,300. The salary range for Connecticut/Nevada residents is $72,800 to $129,900. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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.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

Keywords: UnitedHealth Group, Minnetonka , Sr Clinical Quality RN - SNP Monitoring - Telecommute, Healthcare , Minnetonka, Minnesota

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