Clinical Quality Registered Nurse - Remote (Mountain Standard Time)

About the Role

Join UnitedHealthcare in our mission to simplify healthcare, promote healthier communities, and break down barriers to quality care. Your impact will reach millions as you contribute to creating a more affordable, equitable, and responsive health system. We are seeking a Clinical Quality Registered Nurse (RN) to provide thorough quality of care (QOC) investigations, manage the Incident/Accident/Death (IAD) regulatory portal, and prepare detailed reports for internal teams and external stakeholders. This role involves collaboration with Medical Directors to ensure all investigations conform to state, federal, and regulatory standards, guaranteeing that members receive timely and appropriate care aligned with professional protocols.

Key Responsibilities

• Review clinical documentation of inpatient and outpatient care for Medicaid and Medicare members within Arizona United Health Care Community Plans through peer review and internal quality investigations.
• Compose detailed and professional case investigation summaries suitable for peer review presentations, including presentation to the Provider Advisory Committee when applicable.
• Examine provider corrective action plans addressing substantiated quality of care issues.
• Communicate effectively with facilities, providers, members, and external partners to resolve quality concerns and secure necessary medical records and information.
• Conduct oversight reviews of delegated contractors by auditing contractor work against established audit tools and medical record information.
• Collaborate internally with Medical Directors and various UnitedHealthcare departments to ensure quality compliance.
• Manage multiple responsibilities and shifting priorities while maintaining timely delivery of work and regulatory requests.
• Operate independently, exercising critical thinking and strong verbal and written communication skills.

Required Qualifications

• Active and unrestricted Registered Nurse license in Arizona or a compact RN license.
• Minimum of five years nursing experience, including at least two years in hospital settings.
• Proven expertise evaluating and auditing medical records.
• Intermediate proficiency in Microsoft Office applications, particularly Word and Excel, and the capability to navigate multiple databases.
• Excellent writing skills with the ability to synthesize complex information into concise reports.
• Availability to work the 8:00 am to 5:00 pm shift aligned with Mountain Standard Time.

Preferred Qualifications

• At least one year of experience in quality management or clinical quality investigations.
• Familiarity with Medicare and Medicaid regulatory requirements.
• Strong understanding of quality improvement methodologies and practices.
• Capability to prioritize and perform effectively in deadline-driven environments.
• Experience in Behavioral Health Services is an advantage.
• Compliance with the organization's Telecommuter Policy for remote work.

Compensation and Benefits

The annual salary ranges from $60,200 to $107,400, depending on local labor markets, education, experience, and certifications. Alongside salary, comprehensive benefits include incentive and recognition programs, equity stock purchase options, and 401(k) contributions subject to eligibility. The company adheres strictly to all applicable minimum wage laws.

Commitment to Diversity and Inclusion

UnitedHealth Group is dedicated to enabling equitable healthcare that addresses disparities and promotes positive health outcomes for all, recognizing the unique barriers faced by historically marginalized populations. We are an Equal Employment Opportunity employer and maintain a drug-free workplace. Employment is contingent on passing a drug test.