Utilization Management Quality Auditor San Antonio Texas
6 days ago
About the Company: UnitedHealth Group is a leading health insurance and services company that provides innovative solutions to improve the quality of care and outcomes for its members. Our mission is to help people live healthier lives and to make health care work better for everyone.
About the Position: We are seeking a highly skilled Utilization Management Quality Auditor Registered Nurse (RN) to join our team in San Antonio, Texas. As a Utilization Management Quality Auditor RN, you will be responsible for ensuring the quality and accuracy of medical records and claims data, identifying areas for improvement, and implementing process changes to enhance the efficiency and effectiveness of our utilization management programs.
Key Responsibilities:
- Conduct thorough reviews of medical records and claims data to identify potential errors or discrepancies
- Analyze data to identify trends and patterns that may indicate areas for process improvement
- Develop and implement corrective action plans to address identified issues
- Collaborate with other departments to ensure effective communication and coordination
- Stay up-to-date on regulatory requirements and industry best practices
Requirements:
- Bachelor's degree in Nursing (BSN) or Associate Degree in Nursing (ADN) with 2+ years of experience
- Current unrestricted Registered Nurse (RN) licensure in Texas or participating states
- 5+ years of progressively responsible healthcare experience, including experience in managed care settings
- Knowledge of CMS, URAC, and NCQA regulations and guidelines
- Ability to analyze complex data and develop effective solutions
- Excellent communication and interpersonal skills
Salary and Benefits: The salary range for this position is $90,000 - $120,000 per year, depending on experience. In addition to a competitive salary, we offer a comprehensive benefits package, including medical, dental, and vision coverage, 401(k) retirement plan, and paid time off.
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