QOC Nurse Supervisor – Remote

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

 

This role supports Quality/Patient Safety efforts for the organization. Specifically, this position is responsible for managing front line non-clinical and clinical staff related to businesses process supported by the department.

 

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

 

Primary Responsibilities:

• Excellent working knowledge of systems used for processing of QOC cases 
  • QCare and OCM applications 
  • Microsoft applications (Outlook, Excel, Word, Teams)
  • Adobe Acrobat
  • Demographic systems (such as Facets, MACESS, UNET/COSMOS, NDB, etc.)
  • Auto correspondence application
• Plans, prioritizes, organizes and completes work to meet established objectives
• Able to effectively utilize UHG applications related to QOC case research, including but not limited to written or verbal grievance documents, authorization applications, auto correspondence, and member & provider demographic systems 
• Excellent verbal & written communication skills with internal & external customers
• Interface with other departments as needed (i.e. UHN, A & G, Case Management, Risk Management/Legal.)
• Attend monthly Regional Peer Review Committee meetings
• Manage team huddles and oversee team case inventory and adjust caseloads as needed
• Manage role specific meetings to discuss topics to educate and/or improve processes
• Coordinates work activities with other supervisors/managers
• Responsible for updating department Standard Operating Procedures (SOPs) and job aids
• Monitor performance through multiple reports, including but not limited to the following:
  • Day Counts cases received monthly to assess for data entry errors and delayed cases
  • Triage Closed Records monthly to assess for inappropriate case volume
  • Triage Analyst Productivity document to assess productivity
  • Triage Queue monthly to assess for incoming referral volume and assure timeliness on responses
  • Run Open Case report weekly and assess QOC cases > 60 days old for potential barriers to timely case closure; review outliers with case owners and assist as needed
  • Run Cases Received report weekly to evaluate for case data accuracy and completeness
  • Run Closed Cases report weekly to evaluate for case data accuracy and completeness
  • Prepare Key Performance Indicator (KPI) report monthly for NVP and identify root cause for outliers for TAT and fluctuations in case volume experienced 
  • Collaborate with QOC managers for internal committee reporting
  • Collaborate with QOC managers for external regulatory agency reporting
• Monitor staff attendance and evaluate PTO requests for approval based on business needs
• Manage staff performance issues through coaching and corrective action plan process as needed
• Evaluate staff performance throughout the year and during MAP/ YIR (year in review)
• Special projects as assigned by QOC manager, director or NVP 

 

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:

• Undergraduate degree and/or equivalent related experience
• An active, Unrestricted licensed RN
• Solid computer proficiency (Outlook, Excel, Word, etc.)
• Demonstrated ability to effectively utilize UHG applications including but not limited to authorization applications, auto correspondence, and member and provider demographic systems
• Demonstrated excellent verbal and written communication skills with internal and external customers
• Demonstrated solid analytical and research skills
• Designated quiet workspace in your home (separated from non-workspace areas) and able to be secured to maintain Protected Health Information (PHI) and/or Protected Information (PI)
• Access to install secure high-speed internet (minimum speed 5 download mps and 1 upload mps) via cable / DSL in home (wireless / cell phone provider, satellite, microwave, etc. does NOT meet this requirement)

 

Preferred Qualifications:

• 2+ years of Appeals and Grievances experience
• Supervisory experience
• Experience working on a virtual team
• Available to work 8am-5pm

 

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

 

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $71,200 to $127,200 annually based on full-time employment. We comply with all minimum wage laws as applicable. 

 

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

 

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. 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.

 

 

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.

 

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