Senior RN Clinical Quality Auditor - Remote

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

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 and 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
   

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required 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

Preferred Qualifications:

• 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

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy  

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $72,800 to $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

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.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.    

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.      

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.