Clinical Quality Manager - Albuquerque, NM - Telecommute

Careers at UnitedHealth Group

We're creating opportunities in every corner of the health care marketplace to improve lives while we're building careers. At UnitedHealth Group, we support you with the latest tools, advanced training and the combined strength of high caliber co-workers who share your passion, your energy and your commitment to quality. Join us and start doing your life's best work. SM

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Compassion. It's the starting point for health care providers like you and it's what drives us every day as we put our exceptional skills together with a real feeling of caring for others. This is a place where your impact goes beyond providing care one patient at a time. Because here, every day, you're also providing leadership and contributing in ways that can affect millions for years to come. Ready for a new path? Learn more, and start doing your life's best work. SM

Our teams are helping people from around the world. We can bring out your best as you put your listening, analytical and problem solving skills to work in a setting that is geared to helping improve lives and enhance health care for millions. Here, you'll discover a wealth of pathways for professional growth within Customer Service, Billing, Claims, Enrollment & Eligibility and across our global economy. Join us and find out why this is the place to do your life's best work. SM

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

Positions in this family include those responsible for functions in areas such as health services, clinical services and delivery of clinical care. Positions in this function are responsible for direction and guidance on clinical quality improvement and management programs including accreditation and health plan delegation. Conducts clinical quality audits and may also be responsible for NCQA requirements. Responsible for the reporting and analysis of member care quality and for the development of plans and programs to support continuous quality improvement.

Primary Responsibilities:
  • Manages and is accountable for professional employees and/or supervisors
  • Impact of work is most often at the local level
  • Sets team direction, resolves problems and provides guidance to members of own team
  • May oversee work activities of other supervisors
  • Adapts departmental plans and priorities to address business and operational challenges
  • Influences or provides input to forecasting and planning activities
  • Product, service or process decisions are most likely to impact multiple groups of employees and/or customers (internal or external)


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:
  • Undergraduate degree or equivalent experience
  • Current, unrestricted NM RN license or temporary NM license with the ability to obtain permanent NM RN license upon expiration
  • 5+ years of clinical experience
  • 2+ years of clinical quality experience
  • 2+ years working in managed care or in the insurance industry
  • 2+ years of experience with Medicare and/or Medicaid
  • 2+ years of experience managing licensed and unlicensed employees
  • Experience presenting to executive leadership, internal/external auditors, including developing presentations, reports in Excel
  • Ability to evaluate medical records with attention to detail to perform quality audits
  • Knowledge base of clinical standards of care, preventive health standards, NCQA, governing and regulatory agency requirements
  • Proficiency in software applications that include, but are not limited to, Microsoft Word, Microsoft Excel, Microsoft PowerPoint
  • Ability to travel 15% (as needed) to visit contracted Providers/Vendors
  • Access to reliable transportation that will enable you to travel to client/patient sites


Preferred Qualifications:
  • Masters Degree in Nursing or Business Administration
  • CPHQ certification
  • Demonstrated ability to assist with focusing activities toward a strategic direction as well as develop tactical plans, drive performance and achieve targets
  • Subject matter expert for CMS
  • Experience with project coordination and project management
  • Solid organizational skills, self-motivated and ability to interact with company staff at all levels


*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Colorado Residents Only: The salary range for Colorado residents is $87,900 to $156,900 (add additional reference for sales and physicians). 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

UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

Diversity creates a healthier atmosphere: UnitedHealth Group is a 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.

Job Keywords: Clinical Quality Manager, Albuquerque, NM, New Mexico, AZ, Arizona, Telecommute, Telecommuter, Work From Home, Remote

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