Clinical Quality RN, LVN Or LPN

Unitedhealth Group Inc. Ontario , CA 91761

Posted 4 months ago

Assorted QI activities including but not limited to managing QI committees, medical record and site audits, quality reviews, targeted focus on various STARs measures, including Part D Adherence measures, including member and provider activities.

North American Medical Management, California, Inc. (NAMM California) partnered with OptumHealth in 2012. NAMM California and OptumHealth share a common goal of bringing patients, physicians, hospitals and payers closer together in the mission to increase the quality, efficiency and affordability of care. NAMM California is a part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system. NAMM California develops and manages provider networks, offering a full range of services to assist physicians and other providers in supporting patient care coordination and their managed care business operations. For over 18 years, NAMM California has been an innovator in health care with a track record for quality, financial stability, extraordinary services and integrated medical management programs. NAMM California is well positioned to continually invest in its infrastructure and systems for the benefit of its provider clients and to accommodate the impending changes that will come forth from healthcare reform.

The NAMM California provider clients represent a network of almost 600 primary care physicians and over 3,000 specialists and work with the premier hospitals in their respective markets.

As a part of our continued growth we are searching for a new Clinical Quality Nurse to join our team. Schedule: Monday-Friday: 8am-5pm-Position will split time out of San Diego office and Vista, CA office. Some flexibility

Primary Responsibilities:

  • Clinical quality Case Reviews to include case preparation for Physician Peer Review Committee meetings

  • Ensure that clinical grievances, complaints and complex issues are investigated and resolved

  • Follow - up actions items are communicated to the Plan and Providers in a timely manner

  • Engage with physician and physician staff regarding PCP office performance

  • Working on various Quality initiatives

Required Qualifications:

  • Current and unrestricted RN, LVN or LPN license in California
  • 2 years of Clinical Nursing experience
  • 1 year of Previous Utilization Management or Quality Improvement experience

Preferred Qualifications:

  • Proficiency in Microsoft Office: Outlook, Word, Excel & PowerPoint

  • Inpatient Nursing experience: Acute Care, Medical / Surgical, etc.

  • Managed Care work experience

  • Experience working with the following quality intiatives-P4P, CMS, STARs

North American Medical Management, California, Inc (NAMM California) partnered with OptumHealth in 2012. NAMM California and OptumHealth share a common goal of bringing patients, physicians, hospitals and payers closer together in the mission to increase the quality, efficiency and affordability of care. NAMM California is a part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US healthcare system. NAMM California develops and managers provider networks, offering a full range of services to assist physicians and other providers in supporting patient care coordination and their managed care business operations. For over 18 years, NAMM California has been an innovator in health care with a track record for quality, financial stability, extraordinary services and integrated medical management programs. NAMM California is well positioned to continually invest in its infrastructure and systems for the benefit of its provider clients and to accommodate the impending changes that will come forth from healthcare reform. The NAMM California provider clients represent a network of almost 600 primary care physicians and over 3,000 specialists and work with the premier hospitals in their respective markets.

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: Clinical, RN, LVN, Quality, P4P, CMS, STARs, IPA, utilization management, managed care, inpatient, San Diego, Vista, CA, California


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Clinical Quality RN, LVN Or LPN

Unitedhealth Group Inc.