Senior Clinical Quality Auditor

3 weeks ago

Draper, United States UnitedHealth Group Inc. Full time

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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

For you, quality counts. For UnitedHealthcare, part of the UnitedHealth Group family of businesses, delivering quality care starts with processes and documentation standards that are the best in our industry. As a Senior Clinical Quality Auditor, you'll be a force for positive change, guiding the development of comprehensive care plans that will help others live healthier lives. Join us and help guide our efforts to improve the patient experience.

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

* Complete treatment record review audits and provide feedback results
* Implementing audit plan for Behavioral Health Providers at all covered levels of care for treatment of mental health and substance use disorders
* Initiate and monitor provider corrective action plans (CAPs) as appropriate to improve performance
* Travel to Utah to conduct on site audits on an occasional basis
* Develop and present recommendations and alternatives to improve quality and/or outcomes for management and executive review
* Participate in developing and implementing effective analysis, research and evaluation of quality management metrics
* Collaborate in the design, creation and implementation of quality improvement projects and initiatives
* Manage and host audit of the customers to include scheduling, organizing records, completing and submitting reports

In addition to fostering teamwork and collaboration, much of your work will involve data analysis. Solid auditing skills are essential. You'll also need the communication and persuasion skills to deal with clinical and non-clinical audiences.

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:

* Currently licensed as a mental health therapist in the state of residence
* 3+ years of professional mental health experience
* Experience auditing behavioral health clinical records
* Experience developing and implementing performance improvement projects or using data to develop intervention strategies to improve outcomes
* Proficient in Microsoft Word, PowerPoint and Excel
* Professional writing and verbal communication skills when interacting with customers and behavioral health providers
* Proven ability to collect, analyze and present data
* Proven ability to travel to Utah locations to conduct on site audits of providers
* Designated work space and access to install secure high speed internet via cable/DSL in home '

Preferred Qualifications:

* Experience with quality measures such as HEDIS
* Experience investigating quality of care concerns and critical incidents
* Experience identifying data targets and analyzing results related to quality improvement/performance outcomes
* Knowledge of the behavioral health services in Salt Lake and Tooele Counties
* Knowledge of Medicaid rules and regulations especially 42CFR
* Knowledge of ASAM Dimensions and use for assessment and treatment planning
* Proven to initiate projects and can work on tasks independently
* Proven to collaborate as a team player to achieve department goals
* Proven to design, create and implement quality improvement projects and initiatives
* All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The salary range for this role is $70,200 to $137,800 annually. 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.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment

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