Community Care RN, Full Time

Company: UnitedHealthcare
Location: Scottsdale
Posted on: May 8, 2025

Job Description:

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities, and removing barriers to quality care. Come build the health care system of tomorrow, making it more responsive, affordable, and equitable. The Senior Clinical Quality of Care RN will be responsible for conducting quality of care (QOC) investigation, review and management of the regulatory Incident/Accident/Death (IAD) portal, documenting and communicating findings from these reviews, and preparing reports or summaries for internal and external customers. This position collaborates with the Chief Medical Officer or other Medical Directors to review QOC and other investigations and ensures that QOC investigations comply with all applicable State, Federal, and regulatory requirements. These activities are used to ensure care and services provided to our members are timely, adequate, and compliant with regulatory and professional standards and guidelines.
These QOC investigations are specific to Arizona Medicaid and Medicare members.
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This position is an Arizona based remote position with the option of working 40% in-office. There is travel up to 25% of the time based on business needs. In-office may be required based on performance metrics. The office is located at 1 East Washington Street in Phoenix.
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If you are located within the state of Arizona, you will have the flexibility to work remotely* as you take on some tough challenges.
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Perform clinical documentation review of inpatient and outpatient care delivered to adults and children with Medicaid, Medicare health care benefits through Arizona United Health Care Community Plans for peer review and internal investigations of Quality of Care concerns
Effectively interface with external customers, facilities and providers to resolve quality of care concerns, obtain medical records and other information
Conduct delegated oversight reviews of contractors that perform work on behalf of UnitedHealthcare. This includes reviewing samples of contractor work against an audit tool or information found in medical charts
Collaborate internally with Medical Directors and staff in other UHCCP departments
Manage multiple tasks and projects and changing priorities; Occasional on-site provider visits may be required for potential Quality of Care concerns
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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.
Active, unrestricted RN license in the state of Arizona
-5+ years of experience working as a Registered Nurse
-2+ years of hospital experience as a Registered Nurse
- Experience evaluating and auditing medical records
- Proven intermediate skills in Microsoft Office, Word, and Excel ability to work with multiple data bases to retrieve and enter information
- Ability to travel up to 25% within the state of Arizona
- Quality Management experience in a healthcare setting
Experienced with Behavioral Health Services -
Knowledge of Medicare/Medicaid regulations
Experience with medical record review and identification of quality of care concerns

*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). At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. 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.
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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.
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UnitedHealth Group is a drug - free workplace.

Keywords: UnitedHealthcare, Scottsdale , Community Care RN, Full Time, Healthcare , Scottsdale, Arizona