Optum Clinical Review Coordinator Jobs (NOW HIRING)

Typically Monday-Friday business hours with occasional weekend and shift work as needed to support assigned service line. This is a hybrid role offering some limited remote work opportunity.

Pay Range:

The Clinical Review Coordinator provides local quality, outcomes, and performance improvement support for assigned service lines while aligning local priorities, measures, and improvement work with enterprise service line goals. The role combines clinical review, data integrity, analytics, project coordination, quality reporting, and frontline/provider engagement to help identify improvement opportunities, support reliable care processes, and advance measurable outcomes.

This role will support the Women & Children's Service Line. Seeking an experienced Registered Nurse with a passion for quality improvement, performance excellence, and advancing outcomes across Women & Children's services. This role requires a clinically strong RN who can effectively partner with physicians, advanced practice providers, nursing leaders, and frontline teams to identify improvement opportunities and lead data-driven performance improvement initiatives. The ideal candidate possesses strong analytical and critical thinking skills, along with a willingness to learn and become proficient in healthcare data analysis, quality and safety metrics, regulatory and accreditation requirements, performance improvement methodologies, and outcomes measurement.

• Coordinate local service line quality and outcomes improvement activities in partnership with physicians, advanced practice providers, nursing leaders, frontline teammates, quality leaders, and enterprise service line partners.

• Screen and review medical records, clinical documentation, registries, dashboards, and other data sources to identify quality, safety, clinical outcomes, resource utilization, and regulatory improvement opportunities.

• Maintain accurate databases, registries, scorecards, dashboards, project trackers, and supporting records to ensure information is available, reliable, retrievable, and aligned with applicable reporting standards.

• Ensure integrity, accuracy, validity, and completeness of assigned data by applying measure definitions, resolving data conflicts, validating source information, and identifying data integrity concerns.

• Analyze trends in performance metrics and service line dashboards; translate findings into concise reports, presentations, action plans, and recommendations for frontline teams, providers, committees, and leaders.

• Facilitate performance improvement efforts using established improvement methods such as the Model for Improvement, Lean thinking, root cause analysis, process redesign, action planning, and measurement of outcomes.

• Lead or support multidisciplinary improvement teams, committees, case review processes, and management action plans to implement and sustain evidence-based practices and standard work.

• Support medical staff quality activities, peer review processes, case reviews, medical record audits, and documentation education consistent with role scope and organizational requirements.

• Serve as a local liaison to the enterprise service line by sharing local performance insights, supporting standardization, escalating barriers, and helping deploy enterprise priorities, best practices, and strategic initiatives.

• Partner with local and enterprise stakeholders to define key performance indicators, develop measurement tools, monitor progress, and evaluate the effectiveness of improvement actions.

• Provide education, coaching, and consultation to providers and frontline staff regarding clinical data, quality measures, documentation requirements, regulatory expectations, and improvement methods.

• Stay current on leading practices, evidence-based guidelines, regulatory and accreditation requirements, and enterprise service line priorities relevant to assigned clinical areas.

• Support accreditation, regulatory readiness, special projects, annual service line/outcomes reporting, and other duties as assigned.

Graduate of an accredited school of Professional Nursing

BSN

None

CPHQ

At least 5 years clinical experience. Prior Women & Children's experience strongly recommended.

Our CommitmenttoYou:

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more - so you can live fully at and away from work, including:

Compensation

• Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training

• Premium pay such as shift, on call, and more based on a teammate's job

• Incentive pay for select positions

• Opportunity for annual increases based on performance

Benefits and more

• Paid Time Off programs

• Health and welfare benefits such as medical, dental, vision, life, andShort- and Long-Term Disability

• Flexible Spending Accounts for eligible health care and dependent care expenses

• Family benefits such as adoption assistance and paid parental leave

• Defined contribution retirement plans with employer match and other financial wellness programs

• Educational Assistance Program

Note: Eligibility for programs listed above may depend on your FTE or status (e.g., full-time, part-time, per diem, temporary, etc.); please ask a Recruiter for more information during an interview.