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UnitedHealth Group VA CCN Clinical Quality Patient Safety Specialist - Behavioral Health - Telecommute in Eden Prairie, Minnesota

UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm)

This position works under the direction of the CQM Manager. The individual in this role will focus on investigating behavioral health 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 behavioral health and occasional medical surgical potential quality issues (PQIs), patient safety issues, sentinel events and serious reportable events 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

  • Works predominately in Microsoft Office products (Word, Excel, Power Point), Visio, and quality databases to track and trend quality issues

  • Conducts root cause analysis for sentinel events and serious reportable events

  • Organizes and maintains current investigation information about cases through documentation in quality of care and quality of service databases

  • Communicates in writing to health care providers, track timelines, and performs 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 in the compilation of trending data and quality reports for presentation at CQM Committees

  • Assists with quality studies and focused reviews by abstracting medical records for specified criteria

  • Participates in quality committees and presents cases to peer review quality management committee

  • Develops peer review cases and other quality improvement activities

  • Collaborates with Medical Directors on quality issues as needed

  • Reads, interprets, and documents standards / requirements and / or technical specifications (e.g.,NCQA, NQF, WinQi, HAC)

  • Works with stakeholders for review / approval of results

  • Actively participates in meetings

  • Trains others on relevant policies, rules, and regulations

  • Serves as a resource providing explanation and expertise

  • Maintains confidentiality and non - discoverability of all activities

  • Performs all 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:

  • LCSW or RN with current, active license without restriction in required state(s)

  • 3+ years of behavioral health (inpatient / outpatient / partial hospitalization program / residential treatment center) experience

  • 1+ years of clinical quality management experience or equivalent

  • Medical record chart abstraction and peer review experience

  • Ability to investigate, analyze, synthesize, and formulate conclusions for multiple sources of complex data

  • Strong computer skills with emphasis on Microsoft Office software (Windows, Word, and Excel) and databases

  • Ability to organize quality data in appropriate reporting formats

  • If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders

Preferred Qualifications:

  • BSN

  • General knowledge of Medicare, VA, TRICARE, or other government health care program

  • Quality experience within a managed care organization

  • Excellent interpersonal, communication and writing skills

  • Ability to work in a fast-paced dynamic environment; adaptable and flexible

  • Detail oriented, highly organized, and manages time effectively

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)

Colorado Residents Only: The salary/hourly range for Colorado residents is $53,300 to $95,100. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.

*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.

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

Job Keywords: VA CCN, Clinical Quality Patient, Safety Specialist, Behavioral Health, LCSW, RN, Telecommute, Telecommuting, Telecommuter, Remote, Work from Home, Eden Prairie, MN, Minnesota