Sr Clinical Quality RN - Remote in CST or EST

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

Position Description

The Optum at Home Pharmacy Stars Team provides a variety of services including United HealthCare at Home (UAH) strategic Medication Adherence outreach initiatives, Care of Older Adults (COA) medication reviews/health assessments, SUPD/SPC provider consultations as well as Poly ACH and COB outreach. Additionally, the team does various outreaches during the year targeted at improving stars measures such as BP and DM consultations with members. The team also supports APC providers via a clinical consultation service. All services are provided by a team of Clinical Pharmacists, with the support of Pharmacy Technicians, and Sr Clinical Quality RN’s that engage with plan members and their healthcare providers in a telephonic environment.

The Sr Clinical Quality RN will report directly to the Senior Manager. The Clinical Quality RN will perform telephonic, patient-centered clinical consults focused on CBP and A1C measures. The RN will be required to meet or exceed established productivity and quality metrics and work to support the hours of operation of the business (Mon-Fri 9am-5:30pm local time zone).

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Schedule: 9:00am-5:30pm or 10:00am-6:00pm

Primary Responsibilities

• Adheres to department’s metrics and established advanced protocols and to handle patient telephonic outreach
• Make outbound calls while adhering to established protocols and scripting
• Complete patient assessments for CBP and A1C measures
• Complete patient assessments for Medication Adherence outreach for MAC, MAD, MAH
• Educate patients on health conditions and necessity of routine screening and assisting with appointment scheduling (A1c, Controlling Blood Pressure, Medication Adherence etc.)
• Communicate with providers and offices to obtain needed evidence of completed lab work, screenings and care provided
• Review available medical records for core measures to submit for closure of HEDIS/STARS measures
• Assist patients with identification of and connectivity to community and program resources to assist with non-medical needs
• Document thoroughly all calls and actions taken within core systems.
• Performs all other related duties as assigned
  
  

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

• Must hold active, unrestricted Registered Nurse eLNC Compact licensure in state of residency
• 2+ years of RN experience, including experience in a managed care setting
• 1+ years of reviewing electronic medical records and charts
• Must be proficient with Microsoft Word, Excel, Outlook
• Designated secure and private workspace free of distraction and protecting HIPAA confidentiality of our members. No childcare permitted during working hours
• Access to install secure high-speed internet via cable/DSL in home
  
  

Preferred Qualifications

• Undergraduate degree, post graduate degree
• 1+ years of Call Center Experience
• 1+ years of experience in HEDIS/Star programs, preferably in a clinical quality consultant role
• Solid knowledge of the Medicare HEDIS/Stars measures
• Demonstrated ability to interact with medical staff, peers, and internal company staff at all levels.
• Demonstrated ability to manage multiple complex, concurrent projects
• Bilingual (Spanish, Vietnamese, Russian, Cantonese)
• Proven excellent written and verbal communication and relationship building skills
• Proven solid problem-solving skills; the ability to analyze problems, draw relevant conclusions and devise and implement an appropriate plan of action
• Proven excellent customer service skills and communication skills
• All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
  
  

The salary range for this role is $71,600 to $140,600 annually 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.

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.

UnitedHealth Group 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.

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