Remote Clinical Quality RN in EST or CST


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Requisition Number: 2179203
Job Category: Nursing
Primary Location: Minnetonka, MN
(Remote considered)

For those who want to invent the future of health care, here’s your opportunity. We’re going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life’s best work.(sm) 


The Clinical Quality RN is a subject matter expert for Primary Source Verification and Supplemental Data Entry. They assist with the coordination of HEDIS® and STARs data gathering within Cozeva, DataRAP and other applications as needed. This role evaluates the quality and completeness of clinical documentation, by performing quality medical record reviews, assisting in the improvement of the clinical documentation process, maintaining accurate records of review activities, ensuring all data submitted to the health plan meets the HEDIS®/Star technical specifications for medical records. This role assists the Supervisor of Quality Operations with over reads and quality assurance checks.


If you are located in EST or CST time zones, you will have the flexibility to work remotely * as you take on some tough challenges. 


Primary Responsibilities:

  • Review and abstract medical record data into appropriate application(s)
  • Primary source verify abstracted medical record data
  • Over read abstracted and verified medical record data
  • Analyze chart data, evaluate for possible data integrity and/or data deficits and document findings
  • Provide education and feedback to primary source verifiers and/or abstractors
  • Support chart chase processes by requesting records from provider offices as needed
  • Navigate multiple documentation systems and obtain medical record sections supportive of HEDIS/Star measures
  • Support and improve communications between market and corporate departments
  • Maintain education/knowledge base of HEDIS®/STARs standards and guidelines
  • Assist with process improvement
  • Performs all other related duties as assigned


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:

  • Associate degree
  • Registered Nurse
  • 3+ years of experience with data analysis/quality chart reviews. Able to review data and provide recommendations for improvement
  • 2+ years of HEDIS®/STAR experience
  • Experience using Microsoft office applications, including databases, word-processing, and Excel® spreadsheets


Preferred Qualifications:

  • Undergraduate degree
  • Certified Professional Coder
  • 1+ years of process improvement experience
  • Experience in training and excellent presentation skills
  • Proven ability to be flexible in a continuously changing environment
  • Proven excellent communication practices, both oral and written


Physical and Mental Requirements:

  • Ability to lift up to 25 pounds
  • Ability to sit for extended periods of time
  • Ability to use fine motor skills to operate office equipment and/or machinery
  • Ability to receive and comprehend instructions verbally and/or in writing
  • Ability to use logical reasoning for simple and complex problem solving


California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The hourly range for California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island or Washington residents is $22.45 to $43.89. 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.


*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy