UnitedHealth Group

Senior Clinical Quality RN | San Antonio, Austin & Waco Markets

UnitedHealth Group$72K — $130K *
Healthcare
5 - 7 years of experience
Job Overview by Ladders

Qualifications

  • Active, unrestricted RN license
  • 5+ years of clinical nursing experience
  • 2+ years of managed care experience with various populations
  • Experience with audits and compliance activities
  • Solid understanding of CMS, NCQA, HEDIS, and regulatory requirements
  • Proficiency in Microsoft Office and AI-enabled tools
  • Proven ability to educate and influence provider leadership.

Responsibilities

  • Support providers in the Houston market on quality and HEDIS initiatives
  • Conduct education sessions regarding performance expectations
  • Perform audits and compliance reviews for delegated oversight
  • Analyze findings to identify trends and recommend corrective actions
  • Lead meetings to communicate performance results
  • Support gap closure and quality improvement initiatives.

Benefits

  • Comprehensive benefits package
  • Incentive and recognition programs
  • Equity stock purchase options
  • 401k contribution options
  • Extensive choice of benefits and incentives.
Full Job Description
Primary Responsibilities:

  • Support contracted providers within the Houston market on quality and HEDIS initiatives
  • Conduct provider and clinic education regarding quality measures and performance expectations
  • Perform delegated oversight activities, audits, monitoring, and compliance reviews
  • Analyze audit findings, identify trends and risks, and recommend corrective actions
  • Lead provider-facing meetings and communicate performance results
  • Support gap closure activities and quality improvement initiatives


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
  • 5+ years of clinical nursing experience
  • 2+ years of managed care experience supporting Commercial, Medicare, Medicaid, or SNP populations.
  • Experience with audits, delegation oversight, utilization management, quality improvement, or clinical compliance activities
  • Experience with quality reporting and audit documentation tools used within delegated oversight programs
  • Solid understanding of CMS, NCQA, HEDIS, and regulatory/accreditation requirements
  • Proficiency in Microsoft Outlook, Teams, Word, Excel, and PowerPoint
  • Proficiency in Microsoft Copilot and general AI-enabled tools
  • Proficiency in educating, influencing, and presenting to providers and clinic leadership
  • Proven ability to navigate multiple EMR platforms used by provider groups
  • Reside in San Antonio, Austin, Waco, TX Market market
  • Willing and able to travel throughout the assigned market as needed
  • Valid driver's license required, along with reliable transportation for local travel


Preferred Qualifications:

  • Advanced degree(s)
  • Experience navigating multiple EMR systems
  • Experience with delegated oversight and accreditation environments
  • Experience working with CMS, NCQA, and managed care quality programs
  • Solid HEDIS knowledge and experience with quality metrics


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 - $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

About UnitedHealth Group

UnitedHealth Group is a medical facility. They offer health technology, health finance, and pharmacy services. They are utilizing clinical data and intelligence to assist in the redesign, automation, and deployment of technology to streamline administrative operations and clinical decision-making. Payment systems for both consumers and providers are critical components of a health-care system.

UnitedHealth Group Careers

Joining UnitedHealth Group means becoming part of a diverse team dedicated to making a difference. As a leader in health services and innovation, our company offers a variety of job opportunities that allow professionals to leverage their skills, drive innovation, and improve lives. Work You’ll Do At UnitedHealth Group, you’ll contribute to a mission-focused environment where your expertise will influence the health and well-being of people worldwide. Our employment opportunities span across a wide range of disciplines, from healthcare specialists to data analysts, ensuring that your career journey is both dynamic and rewarding. Transform Healthcare with Your Expertise UnitedHealth Group stands at the forefront of health innovation. Our team collaborates to deliver solutions that lead to better patient outcomes. Working with us, you’ll find yourself at the intersection of technology, healthcare, and leadership, providing key insights that drive industry transformation. Join Our Global Team As part of our team, you’ll engage with over 300,000 professionals globally, dedicated to building a diverse and inclusive workplace. UnitedHealth Group is not just a company; it’s a community where you can grow your career through continuous learning and leadership opportunities. Our commitment to diversity training ensures that every team member can thrive. UnitedHealth Group Career Development We are committed to your professional growth. Explore career paths filled with promising job opportunities and internships that will harness your potential and expand your capabilities. Whether you’re a seasoned professional or a recent graduate, you’ll find that our career development programs support your ambition at every level. Innovative Work Environment At UnitedHealth Group, innovation is at the core of our operations. We encourage our team to bring forward-thinking ideas that challenge the status quo and lead to breakthrough improvements in patient care. Be Part of a Great Team Our culture fosters a collaborative and supportive environment where every member’s contribution is valued. Enjoy the benefits of being part of a global team that’s committed to making a difference in people’s lives. Future-Proof Your Career With UnitedHealth Group, your career is future-proof. Dive into a range of positions that offer both challenges and rewards. Our robust support system includes unmatched training, development programs, and certification support to propel your career forward. Stay Connected Join Our Team Discover the right position that matches your skills and interests. We are always hiring and look for passionate, curious, and solution-driven team players. Search UnitedHealth Group jobs today and take the first step towards a fulfilling career. Keep Up to Date Stay informed with career tips, insider perspectives, and industry-leading insights you can use today—all from the people who work here. Read Careers Blog Job Alert Emails Customize your subscription to receive job alerts, the latest news, and insider tips tailored to your preferences. Explore the exciting and rewarding opportunities that await at UnitedHealth Group.
Learn more about UnitedHealth Group
Size
350,000 employees
Market Cap
$493.1 billion
Industry
Net Income
$15.4 billion
Founded
1974
5 Year Trend
+9.2%
Revenue
$257.1 billion
NASDAQ

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