UnitedHealth Group VA CCN Clinical Quality Patient Safety Specialist in Minneapolis, Minnesota
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.
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
Location is in Eden Prairie, MN. Telecommuting will be considered based on UnitedHealth Group's Telecommuter Policy.
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.
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
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
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: VA CCN Clinical Quality Patient Safety Specialist, Optum, RN, BSN, VA, TRICARE, or other government health care programs, Nurse, Quality Nurse
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