Delegation Clinical Oversight RN - 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 optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

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

Primary Responsibilities:

• Perform quarterly and ad hoc audits of delegated entities using established methodologies and in accordance with operational, regulatory, accreditation and compliance requirements
• Provide clinical guidance, expertise, and consultative support to delegated entities and internal clinical teams; communicate outcomes to reduce repeat corrective action plans and mitigate regulatory risk
• Document delegated entity communications, issue tracking, demographics, and regulatory implementation activities in the LOGIC system to support trending and historical tracking of gaps, deficiencies, and risks
• Meet timeliness and quality standards for audits aligned with annual business objectives
• Serve as a key resource and primary point of contact for complex or high-risk clinical issues related to delegated business
• Support standardization of documented processes to strengthen delegation performance and improve the member and patient experience
• Analyze quality reporting and related documentation, including non-electronic sources, to identify patient safety risks, clinical errors, and opportunities to reduce medical errors
• Monitor, measure, and report clinical effectiveness, including analysis of accreditation-related activities such as NCQA, CMS, and applicable state regulatory requirements
• Provide coaching and guidance to promote compliance with evidence-based medicine when clinical errors or safety concerns are identified
• Enhance the use of healthcare data to improve quality, transparency, and outcomes
• Leverage AI-assisted technologies to support drafting of correspondence, summaries, and presentations with human review to ensure accuracy, clinical appropriateness, and regulatory compliance

Skills You Will Develop:

• Apply NCQA, CMS, and DMHC standards in daily oversight and monitoring activities
• Maintain flexibility and effectiveness in a fast-paced, changing environment
• Use feedback constructively to improve work processes and outcomes
• Communicate with appropriate assertiveness based on situation and stakeholder needs 
• Strengthen utilization management expertise and identify errors quickly during file audits

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:

• Current, unrestricted RN licensure in state of residence
• 5+ years of clinical nursing experience
• 2+ years of managed care experience (Commercial, Medicare, SNP, and/or Medicaid)
• Clinical operations experience in one or more of the following: Appeals & Grievances, Utilization Management, Clinical Coverage Review, Post-Acute Clinical Management, Medical Claims Review, or health plan audit environments
• Proficiency with Microsoft products, including Excel, Word, and PowerPoint, including AI-enabled features (e.g., Copilot) to improve efficiency and communication in a regulated environment
• Demonstrated ability to identify operational process gaps and clinical gaps in care
• Demonstrated ability to perform root-cause analysis and develop, document, and monitor corrective action plans
• Access to wired high-speed internet

Preferred Qualifications:

• Solid interpersonal and communication skills with the ability to effectively communicate with clinical and non-clinical stakeholders
• Proven ability to work independently, apply critical thinking skills, and solve complex problems
• Detail-orientated with a solid focus on quality improvement
• Ability to meet established timelines and quality expectations

*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 $72,800 to $130,000 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.