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TRICARE Clinical Quality RN - Phoenix, AZ

UnitedHealth Group

Phoenix, AZ
Job Code:
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Job Details

TRICARE Clinical Quality RN - Phoenix, AZ(Job Number:706390)

Talk about meaningful work. Talk about an important role. Let's talk about your next career move. Our UnitedHealthcare Military & Veterans organization has been selected to provide quality health care services for those who serve our nation. This is an opportunity to share in something special; an opportunity for all of us to serve those families who have made our nation stronger. It's an inspiring role and it can inspire your career. Find out more about these opportunities to do your life's best work.(sm)
This position works under the direction of the CQM Medical Surgical Patient Safety Lead and CQM Manager. The individual in this role will focus on investigating medical and surgical potential quality issues / serious reportable events and utilization issues by conducting retrospective chart and focused reviews. 
This is a office position working at 2222 W Dunlap Avenue, Phoenix, Arizona.
Primary Responsibilities:
  • Identifies potential quality issues (PQIs), and serious reportable events (SREs)  by applying best practice standards of care and clinical experience
  • Conducts timely reviews of electronic medical records to meet UHC M&V standards
  • Investigations include research, analysis and preparation of written and verbal case summaries with recommendations for further actions as necessary
  • Ability to organize and maintains current investigation information about cases through documentation in quality of care and quality of service databases
  • Communicate in writing to health care providers
  • Develops peer review cases and other quality improvement activities identified by deviations from accepted standards of care and monitors corrective action plans
  • Assists with focused reviews by abstracting medical records for specified criteria
  • Participates on quality committees and presents cases to peer review quality management committee
  • Collaborates with Medical Directors on complex care identified in PQIs / SREs as needed
  • Performs other duties as assigned

Job Clinical Quality Management
Primary Location US-AZ-Phoenix
Other Location 
Organization M&V Clinical Quality Services
Schedule Full-time
Number of Openings 1
Apply on the Company Site

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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