Clinical Quality Management LPN Auditor
3 weeks ago
At UnitedHealth Group, we're committed to simplifying the healthcare experience and creating healthier communities. As an LPN Auditor in Clinical Quality Management, you'll play a vital role in ensuring the quality of care provided to our members.
Key Responsibilities:- Review and audit Medicaid (AHCCCS) Electronic Visit Verification (EVV) providers and medical records regarding AHCCCS AMPM requirements around EVV
- Review, audit, and evaluate documentation of medical records
- Identify incomplete or inconsistent information in medical records and label missing measures/metrics/concerns
- Review relevant tool specifications to guide chart review
- Verify necessary documentation is included in medical records
- Maintain HIPAA requirements for sharing minimum necessary information
- Based on review of clinical data/documentation, identify potential quality of care issues and potential fraud/waste/abuse
- Refer issues identified to relevant parties for further review/action
- Discuss with provider offices to address and request corrective action plans
- Educate provider representatives/office staff to address/improve auditing processes
- Explain/convey technical specifications regarding action plans/follow up
- 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
We offer a comprehensive benefits package, including paid time off, medical plan options, and education reimbursement. If you're passionate about improving healthcare quality and have a strong background in clinical quality management, we encourage you to apply for this exciting opportunity.
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