Clinical Quality Auditor
4 days ago
At UnitedHealthcare, we're committed to simplifying the healthcare experience and creating healthier communities. We believe everyone deserves access to quality care, regardless of their background or socioeconomic status. As a Clinical Quality Auditor with our team, you'll play a vital role in ensuring that medical providers adhere to regulatory guidelines and deliver high-quality care to patients.
Job SummaryWe're seeking an experienced LPN with a strong background in Medicaid health and provider interactions. The ideal candidate will have excellent analytical skills, attention to detail, and the ability to communicate effectively with healthcare professionals. This is a hybrid-remote role, requiring 50% in-state travel throughout Arizona.
Key Responsibilities:- Review and audit Medicaid EVV providers and medical records to ensure compliance with AHCCCS AMPM requirements
- Analyze and interpret medical records to identify potential quality-of-care issues and fraud/waste/abuse
- Develop and implement quality improvement plans with providers, educate them on proper medical record documentation, and follow up as necessary
- Prioritize providers for medical chart review, identify incomplete/inconsistent information, and label missing measures/metrics/concerns
- Maintain HIPAA requirements for sharing minimum necessary information and demonstrate knowledge of public healthcare insurance industry products
Our mission is to help people live healthier lives and make the health system work better for everyone. We believe in creating a diverse and inclusive workplace where everyone has the opportunity to succeed. If you're passionate about delivering exceptional patient care and making a meaningful impact, we encourage you to apply.
Requirements:- Active and unrestricted LPN license in the state of Arizona
- 3+ years of experience in the Medicaid health field, including provider interactions
- Intermediate level of proficiency with software applications (Microsoft Word, Excel, Teams)
- Reliable transportation for field visits and ability to travel 50% for the position
We offer a comprehensive benefits package, including:
- Competitive base pay: $68,000 - $90,000 per year
- Full and comprehensive benefit program
- Performance rewards and opportunities for growth and development
- Flexible work arrangements and work-from-home options
We're committed to attracting and retaining top talent who share our values and passion for delivering exceptional patient care. If you're ready to take your career to the next level and make a meaningful difference in the lives of others, apply today
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