Job was saved successfully.
Job was removed from Saved Jobs.

Job Details


UnitedHealth Group

Sr Clinical Qlty RN, Remote Shreveport/Monroe

Healthcare

All

Full Time

On Site

No

Shreveport, Louisiana, United States

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)

Positions in this function drive clinical relationships and engagement with physician practices, members, and pharmacies while partnering internally (with areas such as Network contract ACO mgrs., Health Care Economics and Analytics, Medical Directors, Reporting, Health Plan market leaders) with goal of improving health outcomes, well-being, quality, and practice performance while reducing medical costs. Positions are accountable for the full range of clinical practice performance which may include but is not limited to improvement on HEDIS®, and STARs gap closure, coding accuracy, facilitating effective education and reporting, effective super utilizer engagement (e.g. members with complex and/or chronic conditions), and proactively identifying performance improvement opportunities through the use of data analytics, technology, workflow changes and clinical support. These roles develop comprehensive, provider-specific plans to increase their physician practice performance, reduce readmissions, disease management and improve their outcomes. Value based incentives also assist with the providers plan to improve health outcomes.

If you are located in Northern Part of Louisiana, you will have the flexibility to work remotely* as you take on some tough challenges

Primary Responsibilities:

  • Assesses and interprets customer needs and requirements
  • Identifies solutions to non-standard requests and problems
  • Solves moderately complex problems and/or conducts moderately complex analyses
  • Works with minimal guidance; seeks guidance on only the most complex tasks
  • Translates concepts into practice
  • Provides explanations and information to others on difficult issues
  • Mentors, provides feedback, and guides others
  • Acts as a resource for others with less experience
  • Visit providers’ offices to educate them on clinical measures, disease prevention programs and communication resources
  • Provide providers with list of gaps in member services/screenings to improve the overall health of members
  • Perform chart reviews for HEDIS® and for State Required Audits
  • Serve as SME for assigned HEDIS/CMS measures to assist with rate improvement and provider knowledge
  • Serve as SME for Preventative health topics
  • Assist with performance improvement projects
  • Special projects as assigned
  • Works with all clinical teams as a resource for the health management of all patients including member outreach when necessary
  • Implementation of Clinical and Quality initiatives
  • Affordability promotion to include cost analysis, utilization, and quality data improvements
  • Act as lead to pull necessary internal resources together in order to provide appropriate, effective provider education, coaching and consultation. Training will include Stars measures (HEDIS / CAHPS / HOS / med adherence), and Optum program administration, use of plan tools, reports and systems
  • Coordinate and lead Stars - specific JOC meetings with provider groups with regular frequency to drive continual process improvement and achieve goals


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, unrestricted RN licensure in the state of LA
  • 3+ years of clinical nursing experience
  • 2+ years’ experience presenting to others
  • Microsoft Office specialist with exceptional analytical and data representation expertise; Advanced Excel, Outlook, and PowerPoint skills
  • Knowledge base of clinical standards of care, preventive health, and STARS measures
  • Access to high-speed internet
  • Louisiana driver’s license with clean driving record
  • Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation

Preferred Qualifications:

  • Experience working with providers/provider offices
  • Experience working with the Medicaid/Medicare Population
  • Experience working in a managed care environment
  • Experience in managed care working with network and provider relations / contracting
  • HEDIS experience
  • Consulting experience
  • Solid knowledge of electronic medical record systems
  • Solid knowledge of the Medicare market
  • Microsoft Excel
  • Proven relationship building skills with clinical and non - clinical personnel
  • Comfort with reading reports and analyzing data


To 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 employment

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.