Senior Clinical Quality Auditor
UnitedHealth Group - Draper, UT
posted 2 months ago
About the position
For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together. As a Senior Clinical Quality Auditor at UnitedHealthcare, part of the UnitedHealth Group family of businesses, you will play a crucial role in delivering quality care through the development of comprehensive care plans that will help others live healthier lives. Your work will guide our efforts to improve the patient experience, ensuring that our processes and documentation standards are the best in the industry. In this position, you will enjoy the flexibility to work remotely from anywhere within the U.S. while tackling some challenging responsibilities. Your primary duties will include completing treatment record review audits and providing feedback results, implementing audit plans for Behavioral Health Providers at all covered levels of care for the treatment of mental health and substance use disorders, and initiating and monitoring provider corrective action plans (CAPs) as appropriate to improve performance. You will also be responsible for developing and presenting recommendations and alternatives to improve quality and/or outcomes for management and executive review, participating in the development and implementation of effective analysis, research, and evaluation of quality management metrics, and collaborating in the design, creation, and implementation of quality improvement projects and initiatives. Your role will also involve managing and hosting audits of customers, which includes scheduling, organizing records, completing, and submitting reports. Solid auditing skills are essential, and you will need strong communication and persuasion skills to effectively interact with both clinical and non-clinical audiences. You will be rewarded and recognized for your performance in an environment that will challenge you and provide clear direction on what it takes to succeed in your role, as well as opportunities for development in other roles you may be interested in.
Responsibilities
- Complete treatment record review audits and provide feedback results
- Implement audit plan for Behavioral Health Providers at all covered levels of care for treatment of mental health and substance use disorders
- Initiate and monitor provider corrective action plans (CAPs) as appropriate to improve performance
- Travel to Utah to conduct on-site audits on an occasional basis
- Develop and present recommendations and alternatives to improve quality and/or outcomes for management and executive review
- Participate in developing and implementing effective analysis, research and evaluation of quality management metrics
- Collaborate in the design, creation and implementation of quality improvement projects and initiatives
- Manage and host audit of the customers to include scheduling, organizing records, completing and submitting reports
Requirements
- Currently licensed as a mental health therapist in the state of residence
- 3+ years of professional mental health experience
- Experience auditing behavioral health clinical records
- Experience developing and implementing performance improvement projects or using data to develop intervention strategies to improve outcomes
- Proficient in Microsoft Word, PowerPoint and Excel
- Proven professional writing and verbal communication skills when interacting with customers and behavioral health providers
- Proven ability to collect, analyze and present data
- Proven ability to travel to Utah locations to conduct on-site audits of providers
- Designated work space and access to install secure high speed internet via cable/DSL in home
Nice-to-haves
- Experience with quality measures such as HEDIS
- Experience investigating quality of care concerns and critical incidents
- Experience identifying data targets and analyzing results related to quality improvement/performance outcomes
- Knowledge of the behavioral health services in Salt Lake and Tooele Counties
- Knowledge of Medicaid rules and regulations especially 42CFR
- Knowledge of ASAM Dimensions and use for assessment and treatment planning
- Proven ability to initiate projects and can work on tasks independently
- Proven ability to collaborate as a team player to achieve department goals
- Proven ability to design, create and implement quality improvement projects and initiatives
Benefits
- Comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution
