Clinical Quality Management Auditor

15 hours 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 from contacted medical providers to ensure compliance with AHCCCS AMPM requirements.
  • Analyze and track results, identifying areas for quality improvement.
  • Develop and implement quality improvement plans with providers, ensuring accurate and complete documentation.
  • 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 documentation is reflected accurately.
  • 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, Health Spending Account, and Health Savings Account.
  • Dental, Vision, Life, and AD&D Insurance, as well as Short-term and Long-term Disability coverage.
  • 401(k) Savings Plan and Employee Stock Purchase Plan.
  • Education Reimbursement, Employee Discounts, and Employee Assistance Program.
  • Employee Referral Bonus Program and Voluntary Benefits.

At UnitedHealth Group, we are committed to creating a healthier atmosphere and addressing health disparities. We are an Equal Employment Opportunity/Affirmative Action employer and welcome applications from diverse candidates.



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