Clinical Quality RN, Hybrid In Southfield MI

Clinical Quality Nurse

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.

We are seeking a dedicated and detail-oriented Clinical Quality Nurse to join our Quality Improvement team within a Medicaid health plan. This role combines clinical expertise with project management to support quality initiatives that improve member outcomes, ensure regulatory compliance, and enhance provider performance. The ideal candidate will be a licensed RN with experience in managed care and a passion for driving measurable improvements in healthcare delivery.

This position follows a hybrid schedule with three in-office days per week.

Primary Responsibilities:

• Manage and execute quality improvement projects, ensuring timely delivery and alignment with strategic goals
• Apply clinical expertise to support HEDIS data collection, chart reviews, and care gap interventions
• Assist with audit preparation and ensure compliance with Medicaid and accreditation standards
• Collaborate with cross-functional teams to support quality initiatives
• Support member outreach and provider engagement to improve performance on quality metrics
• Prepare reports, presentations, and maintain documentation of project activities and outcomes

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 and unrestricted active RN licensure in Michigan
• 2+ years of clinical experience, preferably in managed care or quality improvement
• 2+ years presentation experience to large and small groups
• Familiarity with HEDIS, NCQA, and Medicaid quality standards
• Proficiency in Microsoft Office (Excel, PowerPoint, Outlook)
• Proven solid organizational and communication skills

Preferred Qualifications:

• Masters Degree
• Six Sigma or Lean Certification
• Certification in Healthcare Quality (e.g., CPHQ)
• Data analytics experience
• Experience in project management or quality improvement roles
• Experience with EMRs, data abstraction, and reporting tools
• Knowledge of Medicaid programs and population health strategies

Skills & Competencies:

• Ability to manage multiple projects and meet deadlines
• Solid analytical and problem-solving skills
• Comfortable working independently and collaboratively
• Detail-oriented with a commitment to continuous improvement
• Ability to translate clinical data into actionable insights

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 $58,800 to $105,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

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.