Job Description

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)

This position works under the direction of the Manager of Patient Safety. The individual in this role will focus on investigating medical and surgical potential quality issues, patient safety events, and sentinel/serious reportable events and utilization issues by conducting retrospective chart and focused reviews. Participate on quality committees.

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

Primary Responsibilities:

* Identifies and reviews medical surgical potential quality issues (PQIs), patient safety issues, sentinel events (SEs) and serious reportable events (SREs) by applying best practice standards of care and clinical experience
* Conducts timely reviews of electronic medical records to meet Optum standards.
* Investigations include research, analysis, and preparation of written and verbal case summaries with recommendations for further actions as necessary
* Conducts detailed root cause analysis (RCA) for sentinel events (SEs) and serious reportable events (SREs)
* Ability to organize and maintain current investigation information about cases through documentation in quality of care and quality of service databases
* Communicate in writing to health care providers, track timelines, and perform follow-up as appropriate
* Develops peer review cases and other quality improvement activities identified by deviations from accepted standards of care and monitors corrective action plans to completion
* Assists with quality studies and focused reviews by abstracting medical records for specified criteria
* Participates on quality committees and presents cases to peer review quality management committee
* Collaborate with Medical Directors on complex care identified in PQIs / SEs / SREs as needed
* Read, interpret, and document standards/requirements and/or technical specifications (e.g. NCQA, NQF, WinQI, HAC)
* Work with stakeholders for review/approval of results
* Actively participate in meetings
* Train others on relevant policies, rules, and regulations
* Serve as a resource providing explanation and expertise
* Maintains confidentiality in all activities
* Performs other 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:

* RN with current, active license in current state
* 3+ years of clinical medical / surgical experience
* Ability to investigate, analyze, synthesize, and formulate conclusions
* Ability to organize quality data in appropriate reporting format

Preferred Qualifications:

* BSN
* Excellent interpersonal, communication, and writing skills
* Strong computer skills with emphasis on Microsoft Office software
* Ability to work in a fast-paced, dynamic environment
* General knowledge of Medicare, VA, TRICARE, or other government health care programs
* Prior quality experience within a managed care company
* Detail oriented and highly organized with effective time management skills
* Ability to work in a rapidly changing environment; Being adaptable and flexible
* Quality of care experience in care delivery
* Clinical quality and patient safety experience
* Participation in the peer review process

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care 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)

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

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.

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

Job Keywords: RN, Quality, QA