LVN QI Specialist
Company: Optum
Location: Redlands
Posted on: June 2, 2025
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Job Description:
Optum is a global organization that delivers care, aided by
technology to help millions of people live healthier lives. The
work you do with our team will directly improve health outcomes by
connecting people with the care, pharmacy benefits, data and
resources they need to feel their best. Here, you will find a
culture guided by inclusion, talented peers, comprehensive benefits
and career development opportunities. Come make an impact on the
communities we serve as you help us advance health optimization on
a global scale. Join us to start Caring. Connecting. Growing
together.
Works in collaboration with the Regional Accountable Teams (RATs),
Site Accountable Teams (SATs), regional QI Specialists, Provider
Services and Risk Management to fulfil their cross-regional
accountability for the performance of clinical site reviews and
chart audit of non-group models (i.e., IPA physician/practitioner
offices) as part of the initial credentialing and re-credentialing
process. Generates Corrective Action Plans and monitors
improvements as required.
Provides Direction To: Licensed Practical Nurses, clerical
assistants, medical assistants, and other non-licensed personnel. -
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Primary Responsibilities:
Clinical Knowledge and Skills
Consistently exhibits behavior and communication skills that
demonstrate Optum's commitment to superior customer service,
including quality, care and concern with each and every internal
and external customer
Schedules and conducts site reviews and chart audits for new
clinicians and as part of the re-credentialing process and/or as
necessary in accordance with NCQA, Optum and other applicable
regulatory standards
Prepares, delivers and follows-up on Corrective Action Plans for
sites not meeting the required critical elements of the site review
and audit process
Forwards all necessary documentation to Provider Services
Provides regional QI office with copies of completed site review
tool, chart audit tool and Corrective Action Plans including any or
all ongoing communication and/or documentation
Collaborates with the QI staff and/or with Provider Services with
suggestions for revision to tools used for site review and/or chart
audit and the implementation of revisions
Assists regional QI Specialists with chart audit of group model
providers as part of the credentialing process and as it
contributes to the Provider Performance review (PPR)
Maintains data as necessary to identify clinicians who have failed
to reach a score of 80% in each section of the chart review and an
overall score of 89%. -Clinicians in this category will be reviewed
yearly
Maintains the confidentiality of site review and chart
audit-related information
Assists in the preparation of accreditation and other regulatory
reviews
Collaborates with QI Specialists and QI Coordinators on projects as
requested by the Director, Quality Improvement
Uses, protects, and discloses Optum patients' protected health
information (PHI) only in accordance with Health Insurance
Portability and Accountability Act (HIPAA) standards
Performs additional duties as assigned
Communication
Maintains open lines of communication with physicians and other
Optum Medical personnel including site leadership, within and
between departments
Maintains confidentiality of all information obtained from patient
records and conversations with patients/significant others,
physicians, and other Optum Medical personnel
Uses discretion and sensitivity during all phone conversations
Uses a non-judgmental approach when talking with patients and
coworkers
Uses available electronic mail/computer systems to communicate
inter- and intra-departmentally as per departmental and/or Optum
Medical protocol(s)
Organizational Skills
Work area reflects neat and organized work habits
Sets priorities effectively to ensure timely completion of assigned
work
Requests assistance as appropriate in order to complete assigned
work and offers to assist others when work load permits
Prepares and leaves complete, concise messages/instructions for
others as needed
Uses time, supplies, and human resources effectively and
efficiently
Documentation
Complete and accurate documentation summarizing site visits
Following Practice Health and Safety policies and procedures to
give guidance in improving staff practice and flow
Leadership
Demonstrates effective problem-solving skills, particularly when
urgent/emergent or unexpected clinical or administrative events
arise in order to maintain both the smooth functioning of the
department and patient/personnel safety
Serves as a catalyst for improving standards of nursing
practice
Demonstrates leadership skills through the ability to set and
attain goals
Serves as an effective role model for professional conduct and
professional practice (e.g., maintaining composure during times of
increased stress)
Provides direction and support, and delegates tasks to professional
and non-professional staff
Serves as an effective preceptor to new staff as needed
Actively participates in departmental staff meetings
Professionalism
Demonstrates self-direction, accountability, sound judgment, and
ethical behavior in all activities
Demonstrates patient advocacy
Maintains a commitment to the spirit of inquiry as evidenced by a
clinical knowledge base that remains current and reflects
understanding of relevant clinical research findings
Other Specific Responsibilities/Duties
Required Travel 75% of time - -
Arrives to work on time or notifies Supervisor or designee as soon
as employee becomes aware that s/he will be absent or tardy, and/or
as per individual department protocol
Maintains an acceptable attendance record as per Optum Medical
policies and procedures
Notifies Supervisor or designee whenever leaving Optum Medical
premises during scheduled work hours
Attends all mandatory meetings and in-services
Dresses according to Optum Medical dress code
Assumes responsibility for reading, understanding, and complying
with information contained in the current Optum Medical Employee
Handbook, Optum Medical Clinical and/or Administrative
Policy & Procedure Manuals, as applicable
Maintains patient confidentiality under all circumstances and
follows all Optum Medical policies regarding confidentiality
Assists Supervisorr and/or designee, and/or other administrative
personnel, when possible, by taking on alternate assignments or
other responsibilities, working additional hours, or altering
regularly scheduled hours, when necessary, for the efficient
operation of Optum Medical
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:
1+ years of post-high school education or a degree from a two-year
college
Current California LVN license
Current Basic Life Support from American Heart Association
Preferred Qualification:
Supervisor and/or Team Lead experience
The hourly range for this role is $19.86 to $38.85 per hour based
on full-time employment. Pay is based on several factors including
but not limited to local labor markets, education, work experience,
certifications, etc. UnitedHealth Group complies with all minimum
wage laws as applicable. 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.
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.
Keywords: Optum, Buena Park , LVN QI Specialist, Healthcare , Redlands, California
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