RN, QI Nurse - Remote

Optum CA is seeking a RN, QI Nurse to join our team. Optum is a clinician-led care organization that is changing the way clinicians work and live.

As a member of the Optum Care Delivery team, you'll be an integral part of our vision to make healthcare better for everyone.

At Optum, you'll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Here, you'll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together.

The Clinical Grievance RN will be responsible to assist in the development, implementation, monitoring and evaluation of Optum's overall quality program, which includes clinical, ancillary, support and medical staff compliance with state, federal and health plan laws, statutes, rules, regulations and standards. The QI Nurse will assist in the clinical quality of care review process, the medical record audit process, and analysis of data for presentation to the Quality Management Committee and other interdepartmental committees. The QI Nurse will collaborate with the Quality Manager to establish goals, identify interventions, and implement activities for process improvement in the Quality Department.

If you have the ability to work Pacific Standard Time (PST) hours, you will have the flexibility to work remotely* as you take on some tough challenges.

Position Highlights & Primary Responsibilities:

• Reviews health plan grievances and assigns an appropriate severity level and issue code
• Create written documentation of quality of care findings, using effective clinical
• Ensure appropriate resolution of member grievances in a timely and appropriate manner
• Identify non-compliance with state, federal, and Health Plan standards when investigating appeals and grievances, and intervene as indicated
• Work with Network Management staff to ensure provider understanding and compliance with required elements of medical record documentation and other clinical practice standards
• Assist in the Quality Medical Director review process by gathering pertinent medical information, presenting the cases, and coordinating interventions as advised by the Medical Director/Peer Review Committee
• Assist in the Quality Peer Review process by gathering information for physician peer reviewers
• Track & trend incidents of service and clinical quality of care issues and identify opportunities for improvement
• Coordinates case reviews with the QI coordinator

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 and valid, unrestricted California RN license
• 2+ years of clinical experience with an IPA, medical group, hospital, or health plan setting
• Proficient with Microsoft Word, Excel and PowerPoint
• Ability to work PST hours

Preferred Qualifications:

• BSN or equivalent
• CPHQ certification
• 1+ years of QM experience
• CCM experience

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

The hourly range for this role is $28.61 to $56.06 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.