-UnitedHealthcare Employer & Individual works with individuals, small businesses and large multi-site employers to provide innovative, affordable benefits services.

-UnitedHealthcare Medicare & Retirement is focused on serving Americans over the age of 50. It is the largest business dedicated to meeting the growing health and well-being needs of aging individuals in the nation, serving one in five Medicare beneficiaries through a comprehensive and diversified array of products and services through four industry-leading businesses.

-UnitedHealthcare Community & State provides high-quality, personalized, public-sector health care programs that help local government agencies improve health outcomes for millions of children and low-income and disabled individuals at an affordable cost.

Together, we’re removing the barriers that keep people from receiving the kind of quality health care that makes a difference. We focus on Integrity, Compassion, Relationships, Innovation and Performance as we empower people to achieve better health and well-being.

UnitedHealthcare is currently staffing for a Clinical Quality RN in the Houston, TX area. Person must live within the Hildago service area. The Clinical Quality RN will be responsible for, but not limited to the following duties:

*Educate providers and office staff on proper billing and coding practices, HEDIS and state mandated quality metrics specifications, provider profiling and pay for performance measurements, and medical record review criteria.

*Support the HEDIS medical record chase to support optimum HEDIS and quality metrics reporting.

*Support Quality Improvement report studies, requesting records from providers, maintaining databases, and researching to identify members’ provider encounter history.

*Participate in and represent at community, health department, and collaborative organizational meetings focusing on quality improvement, member education, and disparity programs.

*Perform annual medical records evaluations, follow up education, and practitioner interventions.  

*Unrestricted, active RN license

*Minimum of five years clinical experience

*Knowledge base of clinical standards of care, preventive health standards, HEDIS, NCQA, governing and regulatory agency requirements, and the managed care industry

*Ability to travel to physician offices 90-100% of the time within the assigned territories (Reliable transportation and valid driver’s license required)

Preferred Qualifications:

*Undergraduate degree or equivalent experience

*Ability to evaluate medical records with attention to detail

*Ability to make formal presentations in various environments

*Computer proficiency in a Windows environment

*Access to high speed internet (company provided)

Come grow and thrive in our culture of innovation and ideas. Because there is no opportunity greater than the quest to help people live healthier lives.

Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.