Senior Clinical Quality Nurse RN, Quality Operations Call Center - Remote

Lensa - Eden Prairie, MN

Job Title: Senior Clinical Quality Nurse RN, Quality Operations Call Center - Remote

Position: Clinical Performance Quality (CPQ) Clinical Programs Operations

Job Type: Full Time

Pay: $71,600 to $140,600 annually

Shift: Mon-Fri 9am-6pm Central

Work Type: Remote

Location

Address:

City: Eden Prairie

State: MN

ZIP Code:

Job Responsibilities

Strictly adheres to department’s metrics and established advanced protocols.
Handles incoming contacts including prescription refill requests, lab results, medical inquiries, patient education, and referral requests.
Makes outbound calls to manage the inbound call queue from patients, patient representatives, providers, and other medical staff.
Reviews patient chart (in EMR) to ensure core measures are being addressed and met per protocol.
Schedules services when core measures are not being met.
Completes patient assessments for Transition of Care and Medication Reconciliation Post Discharge.
Educates patients on health conditions and necessity of routine screening.
Assists with appointment scheduling for various screenings.
Communicates with providers and offices to obtain evidence of completed lab work and screenings.
Reviews available medical records for core measures to submit for closure of HEDIS/STARS measures.
Assists patients with identification of community and program resources for non-medical needs.
Documents thoroughly all calls and actions taken within core systems.
Performs all other related duties as assigned.

Required Skills

Core Skills

Active, unrestricted Registered Nurse eNLC Compact licensure in state of residency
5+ years of RN experience, including experience in a managed care setting
2+ years of experience in HEDIS/Star programs
2+ years of Call Center or Telephonic Outreach experience
2+ years of experience with data analysis and/or quality chart reviews
Experience with Medicare HEDIS/Stars measures
Proficient in Microsoft office applications, including databases, word-processing, outlook, and excel spreadsheets with intermediate skills

Preferred Skills

Undergraduate degree preferred, post graduate degree
Billing and CPT coding experience
Clinical data abstraction experience
Bilingual in Spanish and Vietnamese

Requirements

Experience: 5+ years of RN experience, including experience in a managed care setting; 2+ years of experience in HEDIS/Star programs; 2+ years of Call Center or Telephonic Outreach experience.

Education: Undergraduate degree preferred.

License & Certification:

Active, unrestricted Registered Nurse eNLC Compact licensure
RN licensure in one or more additional states

Schedule:

COVID-19 Requirements: Not Specified

Benefits

Comprehensive benefits package
Incentive and recognition programs
Equity stock purchase
401k contribution

Supplemental Pay

Not specified

Special Notes

Our mission is to help people live healthier lives and make the health system work better for everyone.
We are committed to mitigating our impact on the environment and enabling equitable care that addresses health disparities.
UnitedHealth Group is an Equal Employment Opportunity employer.