Behavioral Health - Sr. Clinical Quality/Delegation RN - Telecommute
Location: Las Vegas, Nevada
Internal Number: 105840292
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)
As part of the Optum Mountain West Regional Behavioral Health team, you will be a key stakeholder in overseeing the quality and delegation initiatives and alignment in each care delivery market. It is our mission to connect and support providers by working together to deliver the most effective and compassionate behavioral health care to each patient we serve. Our core business is contracting directly with health providers to deliver a highly personal care management and service model to their patients.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Review, audit and prepare for delegation requirements from payors
Assist with report preparation and records regarding work function activities and projects
Supports quality improvement and utilization management programs
Participates in and represents the Clinical Quality Team by collaborating with internal business partners focusing on quality improvement
Follow relevant regulatory guidelines, policies, and procedures in reviewing clinical documentation (e.g., HEDIS, Clinical Practice Guidelines, HCC)
In partnership with Regional Quality team, review relevant HEDIS specifications to guide chart review
Participates in or coordinates with other department projects as needed
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.
Current, unrestricted RN license
5+ years of clinical experience
1+ years of clinical quality experience in managed care
Direct experience with quality audits as required of managed care and partnerships
Direct experience in clinical standards of care, preventive health standards, NCQA, governing and regulatory agency requirements
Ability to travel 10-15% (as needed)
Proficiency in Microsoft Office applications
Full COVID-19 vaccination is an essential requirement 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
Experience with payor delegation
Experience with project coordination
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 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)
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
Colorado, Connecticut or Nevada Residents Only: The salary/hourly range for Colorado residents is $66,100 to $118,300. The salary/hourly range for Connecticut/Nevada residents is $72,800 to $129,900. 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
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.