Job was saved successfully.
Job was removed from Saved Jobs.

Job Details

UnitedHealth Group

Clinical Quality Consultant - Telecommute



Full Time

On Site


Elkridge, Maryland, United States

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

The Clinical Quality Consultant Nurse Practitioner (NP) or Physician Assistant (PA) will apply clinical expertise and knowledge of documentation guidelines to ensure the accuracy of clinical documentation for Optum Home & Community and Care Delivery programs. The Clinical Quality Consultant will collaborate with a multidisciplinary team of physicians, advanced practice clinicians and coding professionals as a member of the Clinical Documentation Review team in Optum Clinical Performance. This position will provide support to Optum clinicians and leadership to promote excellence in clinical documentation.

This position is Monday – Friday and reports to the Director, Clinical Documentation Review, in Optum Clinical Performance

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

Primary Responsibilities:

  • Performs clinical chart reviews to ensure documentation accuracy by applying established clinical criteria for the diagnosing of medical conditions
  • Reviews reported diagnoses for clinical validation within the visit note or medical record
  • Identifies documentation errors and opportunities for documentation improvement and documents review findings in a standardized form/audit tool
  • Collaborates with team members as part of the clinical review process to promote a high level of accuracy and consistency of results
  • Meets accuracy and productivity metrics to ensure team achieves established departmental goals
  • Communicates with Optum leaders to address documentation issues and trends
  • Provides coaching to Optum clinicians to improve documentation accuracy
  • Actively participates in all department meetings as scheduled
  • Performs related duties, as required

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:

  • Master of Science in Nursing or higher OR Certification by the National Commission on Certification of Physician Assistants (NCCPA)
  • Current Nurse Practitioner (NP) or Physician Assistant (PA) licensure without restriction in state of residence
  • Nurse Practitioner national certification in Adult, Adult-Geriatric, Family or Acute
  • 5+ years of clinical experience as a Nurse Practitioner or Physician Assistant
  • Solid clinical background in evidence-based medicine including chronic disease management and prevention
  • Experience in ICD-10 coding and documentation requirements
  • Ability to perform a comprehensive chart review of up to 50 medical records per day
  • Technical experience using different EMR systems
  • Proficiency in MS applications (Excel, Outlook, Teams, PowerPoint & Word)
  • Ability to travel for on-site meetings 1-2 times per year
  • Full COVID-19 vaccination is an essential requirement of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance

Preferred Qualifications:

  • Coding certification from AAPC or AHIMA professional coding association or additional coursework/experience in coding and/or Risk Adjustment
  • Experience working with Medicare Advantage programs and CMS Risk Adjustment model
  • Previous work experience in clinical documentation review or in a clinical quality program
  • Experience developing and delivering clinical education and training
  • Flexible and able to adapt to change based on departmental needs
  • Excellent analytical and critical thinking skills
  • Excellent verbal/written communication and interpersonal skills
  • Ability to work independently and as part of a team in a fast-paced environment

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

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.

Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $82,100 to $146,900. The salary range for Connecticut/Nevada residents is $90,500 to $161,600. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

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.

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