Senior Clinical Quality of Care RN - Arizona

About This Role

The Senior Clinical Quality of Care RN will conduct quality of care investigations, manage regulatory incident reporting, and ensure compliance with state and federal regulations. This role is ideal for experienced RNs looking to impact healthcare quality for Arizona Medicaid and Medicare members.

• Location: Phoenix, AZ
• Schedule: Full Time, Day shift
• Work Style: Arizona based remote position with the option of working 40% in-office
• Travel: Up to 25% travel based on business needs
• Pay: $72,800 - $130,000 annually

• Perform clinical documentation review of inpatient and outpatient care for Medicaid and Medicare members.
• Create professionally written case investigation summaries for Peer Review.
• Review plans of correction from providers in response to QOC occurrences.
• Interface with external customers, facilities, and providers to resolve quality of care concerns.
• Conduct delegated oversight reviews of contractors performing work on behalf of United Healthcare.
• Collaborate with Medical Directors and staff in other departments.
• Manage multiple tasks and projects with changing priorities.
• Maintain timeliness for deliverables and regulatory requests.
• Work independently with strong critical thinking and communication skills.
• Conduct occasional on-site provider visits for potential Quality of Care concerns.

• 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

• Active RN license in Arizona required
• Driver's license and access to reliable transportation
• Must reside within the state of Arizona

United Health Group is a leading healthcare provider committed to delivering exceptional patient care. They focus on simplifying the healthcare experience and improving health outcomes for millions of people.