Senior Clinical Quality RN - National Remote

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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

The Sr. Quality Analyst role is part of the Optum Tech Clinical Abstraction Program working for the Optum Tech Clinical Program Manager. This role supports the diverse Optum Tech Clinical Services Program and oversees the Quality Control and Quality Assurance Teams providing leadership, training and guidance implementing the Optum Tech Clinical Abstraction Program Quality Standards and Processes. This role directly supports the Optum Tech Clinical Abstraction Program Manager.

You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Utilizes clinical expertise and knowledge to provide responses to daily clinical queries submitted by the abstraction team
• Utilizing clinical expertise and knowledge, perform comprehensive audits on electronic medical record charts that have been abstracted to ensure accuracy and completeness of the data elements abstracted such as Problems, Medications, Allergies, Histories, Results and other data as defined in the project scope
• Review, re-audit and respond to Abstraction Team rebuttals
• Utilizes appropriate tools, processes, and techniques to perform audits
• Maintains detail-focused Clinical Query and Audit tracking in alignment with the Quality Audit standards
• Identify variations from established Quality standards
• Management and Implementation of Quality Control/Quality Assurance Policy & Procedures, Workflows, and Processes




• Project SOP / Playbooks
• Project QC/QA Templates
• Master Clinical Query log
• Daily Completed Abstracted Chart Log
• Daily Abstraction Team Query Log
• Audit Scorecards
• MS Teams Project Folder Structure
• SS QA Assignment Tracker
• Supervisor for Quality Control Team
• Supervisor for Quality Assurance Team
• Point of Contact for Escalations from QC / QA Teams
• Process & Respond to Clinical Queries
• Perform Clinical Audits as needed
• Collaboration, Support & Oversight of Vendor / Partner Teams for QC/QA Compliance
• Assist with Training Plans, Documentation & Presentation for QC/QA and Abstraction Teams
• QC/QA Team Performance & Productivity Tracking and Review
• Manage QC/QA Communications with QC/QA & Abstraction Teams
• Manage Client Clinical Escalation Communications
• Prepare and Present Program QC/QA Performance Status, Metrics and Updates
• Facilitates QC/QA, Program and Project-related meetings as assigned
• Attend Optum Tech Data Management Team Meetings, Clinical Abstraction Program Client & Team Meetings and others as assigned




• Uses pertinent data and facts to identify and solve a range of problems within area of expertise
• Investigates non-standard requests and problems, with some assistance from others
• Works exclusively within a specific knowledge area
• Prioritizes and organizes own work to meet deadlines
• Provides explanations and information to others on topics within area of expertise

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:

• High School Diploma/ GED (or higher)
• Active and unrestricted LVN, LPN, or RN license
• 3+ years of clinical EHR experience
• 2+ years of computer experience including Outlook, Excel, Word, OneNote, Visio, PowerPoint, and Teams
• 2+ years of experience with any electronic medical records systems (e.g. Epic, GE Centricity, NextGen etc.)

Preferred Qualifications:

• Ability to work in a high-volume production environment
• Ability to perform QC/QA Tasks within specified parameters of quality and timeliness
• Attention to detail and ability to proficiently read and interpret medical records
• Ability to define problems, collect data, establish facts and draw conclusions; must be able to think logically and critically
• Working knowledge of ICD-10 codes
• Comprehensive knowledge of medical terminology
• Working knowledge of HIPAA Privacy & Security

Soft Skills:

• Effective written, verbal, and electronic communication skills
• Ability to communicate effectively with a diverse population
• Strong organizational, prioritization and problem-solving skills

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

The salary range for this role is $89,800 to $176,700 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.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

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.

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