There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Nursing here isn't for everybody. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Ready for a new path? Start doing your life's best work.(sm)
The Clinical Quality Analyst - Nurse Advice Line completes independent, subjective assessments of TRICARE beneficiary calls and cases in accordance with Optum's policies and external customer and regulatory standards. This will ensure adherence to departmental and regulatory data integrity standards and requirements including contractual obligations with State and Federal agencies
This position will support quality audit needs for a 24/7 inbound Nurse Advice Line and we have full-time positions available. Variety of schedules available including Daytime, Evening and Night shifts! This is a work from home / Telecommute position from anywhere in the USA.
Independently use discretion and judgment to evaluate subjective clinical documentation of beneficiary records and engagements to assess performance of nursing skill
Applies advanced knowledge to conduct multispecialty subjective assessments to evaluate the skills of nurses supporting the TRICARE- Global Nurse Advice Line (GNAL)
Consults with Medical Directors to calibrate on subjective assessments to ensure consistency of feedback related to complex, high risk cases
Responsible to ensure evaluation tool components for subjective skill assessments comply with quality standards and follow Optum's policies, contract requirements, State regulations and Accreditation standards
Assist the Clinical Management team, as needed, to determine areas that require immediate remediation and assist Optum's employees to stay ahead of changing information while improving the quality and effectiveness of nurse and consumer engagement
Participate in training and performance improvement related projects to support staff development as well as assist with the training of new employees
The Clinical Quality Analyst will highlight key findings for implementation of performance improvement plans when necessary
Work with colleagues across business units to ensure that process and procedural changes are reflected in staff beneficiarys documentation such as job aids and policies
Assist with gathering data for routine reporting with other team beneficiarys to be used for day-to-day purposes and at meetings
Clearly and completely document audit findings within the audit tracking tool; including issues identified that are unacceptable areas in the workflow, staff call communication, and staff documentation performance indicating improvement is needed for discussion with management and/or at departmental team meetings
Must stay abreast of all customer specific details, to ensure high quality customer service
Please Note: In order to be considered for this position, you must be able to obtain an SF86 Position of Trust which is only available to U.S. Citizens. Our Facilities Security Officer will initiate this process post-offer acceptance. Failure to obtain this will result in termination from this role.
Current, unrestricted RN license in your state of residence
3+ years of RN experience
Proficient level of experience with Microsoft Office applications, and strong technical aptitude
Proven customer service skills and experience
United States Citizenship
Ability to obtain favorable adjudication following submission of Defense Health Agency eQuip Form SF86
Specialty license and experience in Women's Health, Oncology and/or Behavioral Health
2+ years of clinical audit experience (preferably sales and customer service)
1+ year of Clinical Contact Center experience
As a requirement of UnitedHealth Group's contract with the Department of Defense, this position requires U.S. citizenship and proof of favorable adjudication following submission of Department of Defense eQuip Form SF86, (the National Agency Check Legal and Credit or NACLC). Successful completion of the NACLC process is a requirement for continued employment in this role. NACLC processing will be initiated by our TRICARE Security Officer post-offer, and can take 3-6 months for a final decision communication from the Department of Defense. Candidates will be allowed to begin employment with UnitedHealth Group in this role based on an interim clearance, and final results will be communicated as they are received. Failure to obtain final NACLC approval will result in termination from this role.
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system 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)
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.
Job Keywords: Nurse, RN, Quality, Call Center, Bilingual, Spanish, Oncology, Behavioral Health, OBGYN, Audit, Quality, Tricare, Telecommute, Virtual, Work From Home
See job description.