[Hiring] Senior RN Clinical Quality Auditor @UnitedHealth Group

Role Description

The Senior Clinical Quality Auditor will be responsible for supporting care management products and operations reporting to the Manager of Quality for UMR. You will provide general support in reviewing and researching program processes for overall staff compliance.

In addition to fostering teamwork and collaboration, much of your work will involve review of calls and documentation of elements of the call. Solid auditing skills are essential. You will also need effective communication skills, and the ability to effectively collaborate with your team members.

You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Participate in audit preparation, analysis and review complex business processes, systems, workflows, SOPs, policies and procedures to identify and document risks and trends that may be non-compliant with contracts and or statutory requirements.
• Monitor Program staff for compliance to established processes, policies, and guidelines; and identify opportunities to improve process performance.
• Implement and complete UMR UM and care management quality audits and provide coaching to staff and program management based on evaluation results.
• Participate in effective analysis of audit results and identify trends impacting program compliance.
• Collaborate in the design, creation and implementation of quality improvement projects and initiatives.
• Utilize applicable systems/tools to maintain and document Quality metrics/outcomes.
• Participate in Inter-Rater Reliability sessions with internal stakeholders to ensure evaluation consistency.
• Other responsibilities as assigned.

Qualifications

• Current, unrestricted RN license in state of residence.
• 3+ years of proven experience in health plan quality improvement identifying areas of opportunity.
• Demonstrated experience auditing clinical programs in a managed care setting.
• Intermediate proficiency with Microsoft Word, Excel and PowerPoint.

Requirements

• Experience working for UMR.

Soft Skills

• Solid interpersonal skills and high level of professionalism.
• Excellent problem-solving skills with strong attention to detail.
• Excellent written and verbal communication skills.
• Ability to work independently in a remote environment and deliver exceptional results.
• Excellent time management and work prioritization skills.

Benefits

• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase.
• 401k contribution (all benefits are subject to eligibility requirements).

Salary Information

The salary for this role will range from $72,800 to $130,000 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc.

Application Deadline

This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.