Remote Clinical Quality RN – State of Louisiana

UnitedHealthcare

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Requisition Number: 2175529
Job Category: Nursing
Primary Location: Metairie, LA
(Remote considered)

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 to start Caring. Connecting. Growing together. 

 

 

Responsible for the research, oversight, and coordination of Quality Improvement activities in the Primary Care Plus (PCP) Clinics related to the quality of care provided to the patients and their clinical outcomes; HEDIS, Star Rating, and Risk Score Management of the patient population as well as staff training, auditing, and maintenance of quality reporting to include improvement activities. Serves as the main point of contact for Primary Care Plus clinics regarding Quality Improvement.

 

The Clinical Quality RN will identify opportunities to improve processes within all PCP clinics to produce positive trending of quality initiatives and quality improvement program. The Clinical Quality RN serves as a resource for PCP clinical staff by providing education and feedback related to HEDIS and Star ratings, standards of care, current clinical practice guidelines, and required documentation standards.

 

 

If you are located in Louisiana, you will have the flexibility to Work from home and the office in this hybrid role* as you take on some tough challenges.

 

   

 

Primary Responsibilities: 

 

  • Conducts random audits looking for compliance to standards of documentation, appropriateness of codes captured and proper documentation of HEDIS interventions
  • Provides individual and group education/training to clinical providers and staff related to clinical practice guidelines
  • Assists providers with analyzing patient care, trending quality compliance at the provider level, and developing action plans and programs to support provider practices in continuous quality improvement using approved clinical practice guidelines, HEDIS, Stars and other tools
  • Supports the Clinic Manager in efforts associated with responding to quality improvement initiatives by managed care plans
  • Reviews weekly STAR reports and other quality improvement initiatives to create a plan of action for improvement for all clinics
  • Coordinates and facilitates care team meetings at clinic locations that include Primary Care Plus staff. The meeting focus is to develop programs and processes to improve patient outcomes
  • Be an ambassador of the clinics in building the image, foundation, culture and core values
  • Coordinates interactions related to quality improvement initiatives among staff of the Clinics, Corporate and Payors
  • Maintains and/or creates documentation related to Quality Improvement Plan, meeting agendas and minutes, audit reports, staff training, etc.
  • Direct all Quality Improvement activities and ensure compliance with all federal, state and other regulatory requirements and other ‘outcomes’ activities to ensure quality of care for all clinical programs
  • Perform, report findings and assist the clinic manager with corrective actions for the Annual Clinic Health and Safety audits as required by Optum
  • Conducts New Hire and Annual Skills training and assessment of Medical Assistants and LPNs
  • Maintain employee health as it relates to baseline titers and immunizations for patient-facing employees per UHG guidelines
  • Provide assistance, support, and consultation to ensure the full utilization of implemented EMR and practice management systems as it relates to any quality improvement initiatives
  • Attends meetings, seminars, workshops and conferences as needed to stay current with knowledge of industry trends and legislation related to clinic operations, coding, and compliance
  • Assist with Clinic expansion
  • Ensure timely review, updating, and creation of departmental policies, procedures, training manuals and job descriptions as needed
  • Perform other duties as assigned
  • Maintain confidentiality in all matters

 

Core Competencies:

  • Leadership- inspires and motivates others to perform well; leads by example
  • Analytical/Problem solving skills- identifies and resolves problems in a timely manner.  Must be a strategic thinker
  • Planning/organizational skills- prioritizes and plans work activities, uses time efficiently and develops realistic actions plans
  • Collaboration and teamwork- must be capable of working with multiple Corporate departments to coordinate efforts to meet quality initiatives.  Must have excellent interpersonal relationship skills
  • Time Management- Must manage time appropriately, efficiently, and effectively

 

 

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: 

 

  • Registered Nurse in the state of LA
  • 3+ years of clinical experience
  • Quality Improvement background in a clinical environment
  • Proficiency in Microsoft Word and Microsoft Excel
  • Willing to travel to all PCP clinic locations on a weekly basis
  • Available for overnight travel to meetings/conferences occasionally

   

 

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