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Clinical Quality Management Auditor

2 months ago

Tucson, Arizona, United States UnitedHealthcare Full time
Job Summary

We are seeking a skilled LPN Auditor to join our Clinical Quality Management team at UnitedHealthcare. As a key member of our team, you will play a critical role in ensuring the quality and accuracy of medical records for Medicaid providers.

Key Responsibilities
  • Review and audit medical records to ensure compliance with AHCCCS AMPM requirements
  • Analyze and track results to identify areas for quality improvement
  • Develop and implement corrective action plans with providers to address any issues
  • Collaborate with other health plans to prioritize providers for medical chart review
  • Identify incomplete or inconsistent information in medical records and label missing measures/metrics/concerns
  • Review and interpret medical records/data to determine whether there is documentation reflected accurately in medical records
  • Follow relevant regulatory guidelines, policies, and procedures in reviewing clinical documentation
Requirements
  • Active and unrestricted LPN license in the state of Arizona
  • 3+ years of experience in the Medicaid health field, including provider interactions
  • 2+ years of experience reviewing medical record charts/documentation and writing regulatory reports
  • Intermediate level of proficiency with software applications, including Microsoft Word, Excel, and Teams
  • Reliable transportation for field visits
  • Ability to travel 50% for the position throughout Arizona when business requires
What We Offer
  • Paid Time Off and 8 Paid Holidays
  • Medical Plan options, including Health Spending Account or Health Savings Account
  • Dental, Vision, Life, and AD&D Insurance, as well as Short-term disability and Long-term Disability coverage
  • 401(k) Savings Plan and Employee Stock Purchase Plan
  • Education Reimbursement and Employee Discounts
  • Employee Assistance Program and Employee Referral Bonus Program

We are an equal opportunity employer and welcome applications from diverse candidates. If you are a motivated and detail-oriented LPN Auditor looking for a challenging role in a dynamic healthcare environment, we encourage you to apply.