Remote DSNP RN Clinical Quality – Phoenix or Tucson, Arizona


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Requisition Number: 2228250
Job Category: Medical & Clinical Operations
Primary Location: Phoenix, AZ
(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.


If you are located in Phoenix or Tucson, Arizona, you will have the flexibility to work remotely* as you take on some tough challenges. Travel is required about 25% of the time in the state.


Primary Responsibilities:

  • Telephonic and follow-up with members to close care gaps
  • Provider outreach to address care gaps. Following up with provider (via: fax, email, mail, phone call)
  • Chart upload in Practice Assist to close care gaps
  • Support HEDIS chart chase efforts by reaching out to providers to retrieve medical records
  • Support STARS improvement projects, HEDIS, CAHPS measures and provide clinical guidance
  • Support Health Plans as Subject Matter Expert of STARS and HEDIS Technical Specifications, project plans, and reporting logistics
  • Identify and implement opportunities to improve rates or efficiency of data collection
  • Support National Team efforts
  • Educate providers on general policies and procedures applicable to delivery of care
  • Educate providers on proper HEDIS documentation/coding for member compliance
  • Engage providers to introduce new initiatives and monitor success of those in place and to identify issues and ensure effective problem resolution to maintain strong relationships
    • Serves as the primary point of contact, consultative resource, and subject matter expert in all aspects of medical record documentation requirements and coding as they apply to CMS Stars/HEDIS measures
  • Closely work with internal stakeholders and providers to engage members and close care gaps
  • Weekly and monthly productivity reports for outreach (Corral, Provider Letter campaign, Compassion Cards)
  • Ensure projects are completed on time and in scope
  • Support the evaluation and monitoring of HEDIS/Stars specific QM Metrics
  • Monitor of reports and playbook
  • Need to work independently and within an integrated team in a highly matrixed environment
  • Attend weekly/monthly and adhoc Webex meetings with national partners (National Star Operations Meetings, Stars Measure Meetings, and Various measure groups, etc.)
  • Travel locally in Arizona (25%) to meet with provider groups and healthcare quality or policy organizations


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 with no restrictions in state required to practice
  • 3+ years of experience working in a healthcare environment
  • 3+ years of experience of project management
  • 3+ years of experience in tracking, working with large data sets and making data-driven analytical decisions
  • 2+ years of Medicare, DSNP Lines of business
  • 2+ years of Stars, HEDIS measure technical specifications
  • Experience reaching out to member to close care gaps
  • Intermediate or higher level of proficiency with Excel and PowerPoint, including visual representation of quality data and trends, use of basic math and statistics functions
  • Access to reliable transportation with valid driver’s license that will enable you to travel to client and/or sites within designated area
  • Candidate must be based in Arizona (Phoenix, Tucson, or Mesa)


Preferred Qualifications:

  • UnitedHealth Group, Optum, or UnitedHealthcare experience
  • Community & State and or Medicare & Retirement experience
  • Demonstrated ability to communicate ideas clearly and concisely
  • Flexibility and quick adaptation to change is key
  • Continuous improvement mindset
  • Excellent time management, organizational, and prioritization skills and ability to balance multiple priorities


*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.