Title: Senior Clinical Quality of Care RN - Arizona Requisition number: 2341276 Job category: Nursing Primary location: Phoenix, AZ Additional locations: Tucson, Arizona Overtime status: Exempt Travel: Yes, 25 % of the Time Job Description: 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. The Senior Clinical Quality of Care RN will be responsible for conducting quality of care (QOC) investigation, review and management of the regulatory Incident/Accident/Death (IAD) portal, documenting and communicating findings from these reviews, and preparing reports or summaries for internal and external customers. This position collaborates with the Chief Medical Officer or other Medical Directors to review QOC and other investigations and ensures that QOC investigations comply with all applicable State, Federal, and regulatory requirements. These activities are used to ensure care and services provided to our members are timely, adequate, and compliant with regulatory and professional standards and guidelines. These QOC investigations are specific to Arizona Medicaid and Medicare members. This position is an Arizona based remote position with the option of working 40% in-office. There is travel up to 25% of the time based on business needs. In-office may be required based on performance metrics. The office is located at 1 East Washington Street in Phoenix. If you are located within the state of Arizona, you will have the flexibility to work remotely* as you take on some tough challenges. Primary Responsibilities: - Perform clinical documentation review of inpatient and outpatient care delivered to adults and children with Medicaid, Medicare health care benefits through Arizona United Health Care Community Plans for peer review and internal investigations of Quality of Care concerns - Create professionally written case investigation summaries for Peer Review, present case summaries at the Provider Advisory Committee as applicable - Review plans of correction from providers in response to a substantiated QOC occurrence - Effectively interface with external customers, facilities and providers to resolve quality of care concerns, obtain medical records and other information - Conduct delegated oversight reviews of contractors that perform work on behalf of UnitedHealthcare. This includes reviewing samples of contractor work against an audit tool or information found in medical charts - Collaborate internally with Medical Directors and staff in other UHCCP departments - Manage multiple tasks and projects and changing priorities; prioritize work products effectively - Maintain timeliness for deliverables and regulator requests - Must have the ability to work independently, good critical thinking skills, excellent verbal and written communication skills - Occasional on-site provider visits may be required for potential Quality of Care concerns 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: - 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 - Proven intermediate skills in Microsoft Office, Word, and Excel ability to work with multiple data bases to retrieve and enter information - Ability to travel up to 25% within the state of Arizona - Driver's license and access to reliable transportation - Reside within the state of Arizona Preferred Qualifications: - Quality Management experience in a healthcare setting - Experienced with Behavioral Health Services - Experience analyzing information and preparing written summaries - Experience working in a deadline driven environment prioritizing responsibilities - Knowledge of Medicare/Medicaid regulations - Experience with medical record review and identification of quality of care concerns - 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 hourly pay for this role will range from $35.00 to $62.50 per hour based on full-time employment. We comply with all minimum wage laws as applicable. #UHCPJ 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.

Employment Type: Full timeShift: Day Shift Description: Purpose Work Remote Position (Pay Range: $36.8795-$47.8193) The Nursing Support (NS) colleague (uncertified, certified, unlicensed, or licensed) provides safe, quality health care services & / or assistance to patients under the supervision & direction of a registered nurse or other designated health care professional in accordance with level of experience, education, policies & procedures. Note: “patients” refers to patients, clients, residents, participants, customers, members Essential Functions Our Trinity Health Culture: Knows, understands, incorporates & demonstrates our Trinity Health Mission, Values, Vision, Actions & Promise in behaviors, practices & decisions. Work Focus: Performs clinical care activities (direct or indirect) for patients within the “scope of practice” laws & training received; Cares for patients safely by assisting in clinical care services or engaging in administrative activities (e.g., maintaining records or supplies) that enhance or improve coordination, preparation & flow of the care experience. Process Focus: Knows, understands & incorporates basic or essential area of practice (document, coordinate, communicate) & training standards. Communication: Uses clear, effective, respectful language & communication methods / means. Environment: Performs work in a safe, engaging, & supportive manner; Influences the responsible use of resources; Accountable for continuous self-development & supporting the growth of others. Maintains a working knowledge of applicable federal, state & local laws/regulations, Trinity Health Integrity & Compliance Program & Code of Conduct, as well as other policies, procedures & guidelines in order to ensure adherence in a manner that reflects honest, ethical & professional behavior & safe work practices. Functional Role (not inclusive of titles or advancement career progression) NS IV – licensed: Licensed role (direct or indirect healthcare); Provides nursing interventions or clinical knowledge application in decision-making; Participates in the planning, implementation & / or evaluation of & solutions for care; Performs delegated focused / holistic care autonomously according to care plan; May administer medication & carry out the therapeutic treatment within scope of license (state & TH policy); Performs direct & essential care or supportive activities as part of an interdisciplinary team with a deeper understanding, including theoretical knowledge; Demonstrates a level of independence to perform activities with general oversight, through personal contributions, teamwork & initiatives to safely improve outcomes; Advocates for patients & informs / counsels patients & families about illness & care details; May serve as a knowledge resource, role model & mentor or lead / coordinate / supervise direct & essential care activities or role-based service responsibilities of unlicensed / licensed / certified healthcare professionals within licensed scope of practice. Minimum Qualifications High school diploma or GED; Completion of an accredited program associated with license. License in the applicable state(s) of engagement. Valid driver’s license where required by assignment. Additional Qualifications (nice to have) Registered Nurse, preferred Training or experience according to assignment area Nursing Support (NS) IV Physical & Mental Requirements & Working Conditions (General Summary) Direct Healthcare Services / Indirect Healthcare / Support Services: - Exposure to conditions which may be considered unpleasant to sight, touch, sound & / or smell. Occasional - Exposure to fumes, odors, dusts, mists & gases, biohazards / hazards (mechanical, electrical, burns, chemicals, radiation, sharp objects, etc.). Occasional - Exposure to or subject to noise, infectious waste, diseases & conditions. Occasional - Exposure to interruptions, shifting priorities & stressful situations. Frequent - Ability to follow tasks through to completion, understand & relate to complex ideas / concepts, remember multiple tasks & regimens over long periods of time & work on concurrent tasks / projects. Frequent - Ability to read small print, hear sounds & voice / speech patterns, give / receive instructions & other verbal communications (in-person & / or over the phone / computer / device / equipment assigned) with some background noise. Frequent - Perform manual dexterity activities & / or grasping / handling. Continuous - Ability to climb, kneel, crouch & / or operate foot controls. Occasional - Use a computer / other technology. Frequent - Sit with the ability to vary / adjust physical position or activity. Frequent - Maintain a safe working environment & use available personal protective equipment (PPE). Continuous - Comply with Trinity Health’s Code of Conduct, policies, procedures & guidelines. Continuous - Ability to provide assistance in the event of an emergency. Occasional Direct Healthcare Services: - Perform activities that require standing / walking with the ability to vary / adjust physical position or activity. Occasional - Lift a maximum of 30 pounds unassisted. Occasional - Use upper & lower extremities, engage in bending / stooping / reaching & pushing / pulling. Occasional - Work indoors (subject to travel requirements) under temperature-controlled & well-lit conditions. Continuous - Encounter worksites (e.g., patient homes) or travel to worksites that may have variable internal & external environmental conditions. Occasional - Perform work that involves physical efforts (e.g., transporting, moving, positioning & / or ambulating patients). Occasional Indirect Healthcare / Support Services: - Perform activities that require standing / walking with the ability to vary / adjust physical position or activity. Occasional - Lift a maximum of 30 pounds unassisted. Occasional - Experience of long periods of walking / standing / stooping / bending / pulling & / or pushing. Occasional - Encounter a clinical / patient facing / hands on interactive work environment. Occasional - Work indoors (subject to travel requirements) under temperature-controlled & well-lit conditions. Continuous - Work outdoors with variable external environmental conditions. Occasional Average Workday Activity: Occasional - O (1% - 33%), Frequent - F (34% - 66%), Continuous - C (67% - 100%) Nursing Support (NS) IV Addendum Additional minimum qualifications - Four (4) + years of nursing experience - Must possess a demonstrated knowledge of revenue cycle & denial management functions. - Knowledge of & experience in case management & utilization management. - Customer service background is required. Additional Preferred qualifications: - Registered Nurse, preferred. - Bachelor’s degree, preferred. - Two (2) + years of charge audit, managed care or comparable patient payment processing experience preferred. - AAPC, AHIMA, CHRI certification/membership strongly preferred. - Outpatient CDI experience preferred. - Working knowledge of Electronic Health Records (EHR), preferred Responsible for coordinating revenue integrity/ charge-related denials with Patient Business Service (PBS) center & ensures compliant & complete clinical documentation, assists with denials & related audits & identifies opportunities for revenue optimization. Performs thorough and routine chart reviews, providing education to clinical colleagues & tracking of identified trends. Leverages clinical knowledge & standard procedures to ensure timely attention to charge-related trends and provides necessary education to responsible party. Responsible for retrospective charge reviews & assistance with third party charge audits. May require travelling between locations within the region. Ensures tracking of all Revenue Integrity- related audits, identifying trends & collaborating with other Revenue Integrity, PBS & /or departmental colleagues on education & reporting to key stakeholders. Serves as a resource contact, providing clinical information as requested by intra & inter-departmental colleagues & payers. Collaborates with Revenue Integrity team on opportunities to improve & implement front-end process to support denial prevention. Our Commitment Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.

Join a dynamic and innovative team dedicated to excellence in healthcare reimbursement. At Titan, we are committed to ensuring accurate and timely payments, fostering a collaborative environment where your skills will directly impact our mission of identifying underpayment patterns to maximize revenue recovery for our clients. Essential Job Duties/Responsibilities As a Reimbursement Auditor, you will play a pivotal role in ensuring our clients' claims are processed accurately and identifying areas where additional revenue can be pursued. Your responsibilities will include: - Audit Excellence: Conduct thorough audits of hospital insurance claims payments, including Medicare and Medicaid, ensuring compliance with coding rules and payment standards. Perform in-depth research to verify the accuracy of claim payments or the legitimacy of denials, including proactive communication with insurance plans when necessary. - Contract Insight: Analyze contract language to identify potential areas for payment errors before they occur, contributing to proactive management of reimbursement processes. - Error Identification: Detect and verify underpayments by insurance plans, ensuring accurate financial reconciliation for our hospital. - Appeal Craftsmanship: Develop compelling appeal and grievance arguments, including precise calculations of short payments. Draft and submit appeal letters or reconsideration requests via various channels (phone, fax, email, or payor portal). - Appeal Management: Review and audit paid appeal amounts to confirm accurate resolution. Draft and submit secondary appeals when necessary, ensuring comprehensive follow-up on underpaid accounts. - Collaborative Collection: Assist in the collection of appeals by effectively communicating with insurance plans to expedite accurate payments when needed. - Team Culture: Upholds organizational values to help foster a trusting and respectful work environment. Minimum Qualifications - In-Depth Knowledge: Expertise in Commercial, Medicare, and Medicaid claims, including a thorough understanding of billing, coding rules, and claim forms (UB04 and HCFA 1500) and reimbursement. Along with, detailed understanding of CPT/HCPCS and ICD10 coding. - Analytical Skills: Proficiency in contract analysis and interpretation with at least 1 year of experience in contract analysis and hospital or physician claims auditing. - Appeal Experience: Hands-on experience with payor reconsiderations and appeals, including drafting appeal letters and following up with payors. - Technical Skills: Proficiency in Microsoft Office (Word and Excel) with at least 1 year of experience. Certification such as Certified Outpatient Coding (COC) or Certified Professional Coding (CPC) is preferred. - Communication: Exceptional oral and written communication skills, with a focus on customer and client service. Work Environment - Work from home: your workspace should be large enough to work efficiently with reliable internet connectivity. Performance Standards - Attitude: Demonstrate a positive and professional demeanor toward supervisors, co-workers, and clients. - Reliability: Show commitment and initiative in your role, with a strong focus on job performance and follow-through. - Quality: Deliver high-quality work with attention to detail and accuracy. Technical Skills: - High school diploma or equivalent. - Proficiency in Microsoft Office (Word and Excel) with at least 1 year of experience. - 2 years prior experience in reimbursement auditing, contract and financial review. - CPC-A, CPC preferred Salary Range: $20-25 hourly

Job DetailsJob Location: Works from Home Remote - Madison, SD 57042Position Type: Full TimeSalary Range: $60,000.00 - $80,000.00 SalaryTravel Percentage: Occasional Job Shift: DayJob Category: Professional ServicesPLEASE NOTE: If your experience is limited to SOX and ITGC audits at Fortune 500 organizations, this position may not be best suited for you. Your Mission As an IT Auditor with SBS CyberSecurity, you will evaluate organizations, primarily in the financial services industry, including community banks and credit unions. These evaluations provide invaluable insight that will enable these organizations to make more informed cybersecurity decisions, meet regulatory requirements, and understand and implement cybersecurity best practices. You will have the unique opportunity to influence cybersecurity at a different business each week, while making a tremendous impact on security and awareness within various communities. Why Choose SBS? Are you interested in an exciting opportunity to work for an innovative company with a people-focused, collaborative culture in the booming cybersecurity industry? If so, then we want to talk to you! SBS CyberSecurity, LLC (SBS) is a premier cybersecurity consulting and audit firm focused on assisting organizations to achieve and maintain a proactive cybersecurity mindset. We strongly believe our people are our number one asset and strive to provide an enjoyable working environment where employees feel supported, valued, and challenged. Join SBS CyberSecurity, and you will: Be part of a company that makes its culture a priority Enjoy a flexible and family-friendly environment with the benefit of working from home Receive competitive wages and an excellent benefits package with many premiums paid for by the company Be encouraged to continue growing in your profession with reimbursement for industry certifications and education. Work with a team that lives out our core values of passion, compassion, innovation, and empowerment when interacting with customers and each other. What You’ll Do In this role you will: Follow well-defined and highly repeatable audit processes Manage and complete information securityaudits encompassing policy and procedure, information securitycontrols, industry best practices, as well as preparing draft and final reports for clients Manage and complete compliance audits to evaluate policies, procedures and implemented controls Communicate and collaborate with other team members regarding security assessments such as social engineering, penetration testing, and vulnerability assessment Aid in the entire engagement process, from initial customer kickoff to report delivery and follow-up Maintain knowledge of information cybersecurity topics, trends, and standards Occasionally travel to client sites to perform onsite testing and auditing Assist in the development of new processes / procedures to improve the audits and assessments QualificationsWhat You Bring Basic knowledge required in IT infrastructure and management, audit functions and security controls, risk management, network security, network implementation, and information security policies and procedures. Proficiency in clear written and verbal technical and non-technical communication skills is necessary. Ability to manage projects and multitask effectively. A strong customer service mindset is essential for this role. Preferably experienced or knowledgeable in Microsoft 365 administration, network administration, virtual environments, cloud computing, Active Directory, firewall implementation and monitoring, SIEM, wireless technologies, and remote access. 2 or 4 year degree or 2+ years of experience in community banking, bank examination, information or cybersecurity roles, consulting and/or auditing experience is preferred Valid driver’s license required. Must also qualify for SBS insurance coverage Experience in the financial services industry, including community banks and credit unions is preferred. These specifications are general guidelines based on the minimum experience normally considered essential to the satisfactory performance of this position. The requirements listed above are representative of the knowledge, skill, and/or ability required to perform the position in a satisfactory manner. Individual abilities may result in some deviation from these guidelines. Supervisory Responsibility This position will not have direct supervisory responsibility. Additional Details This is a full-time position. This role would require occasional travel. Days and hours of work are Monday through Friday, 8:00 a.m. to 5:00 p.m. Evening and weekend work may be required as job duties demand. On rare occasions, this position may require some after-work hours due to workload or tight deadline. Working Conditions This position is for remote work, with little expected travel. Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is occasionally required to use hands to finger, handle or feel and reach with hands and arms. The employee frequently is required to sit, use keyboard and mouse (or alternative input device), use telephone, and drive. Employee will frequently lift 0-10 lbs and occasionally lift, up to 50 lbs. Travel This position requires minimal travel, i.e. one to two times per year. For this remote, work from home position, you must currently reside, or willing to relocate to, one of the following states prior to first day of employment: AR, AZ, CO, FL, IA, ID, IL, KS, KY, LA, MD, MI, MN, MO, MS, NC, ND, NE, NJ, NM, NY, OH, OK, OR, SC, SD, TN, TX, UT, VA, WI. Other Duties The job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee. Accordingly, the employee will be expected to perform other duties as assigned. This job description is subject to change at any time. We comply with the ADA and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. PAY TRANSPARENCY NONDISCRIMINATION PROVISION We will not discharge or, in any other manner, discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the legal duty of the contractor to furnish information. SBS CyberSecurity, LLC is an equal-opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, sexual orientation, gender identity, age, disability, or status of protected veteran. EEO/AA/M/F/Veteran/Disabled