Clinical Quality Auditor, RN - Remote at UnitedHealth Group Canada

Las Vegas, Nevada, United States -

Full Time

Start Date

Immediate

Expiry Date

24 Jan, 26

Salary

105000.0

Posted On

26 Oct, 25

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Clinical Quality Improvement, Quality Audits, Data Analysis, Communication Skills, Organizational Skills, Problem Solving, Team Collaboration, Attention to Detail, Project Coordination, Medicare, Medicaid, HEDIS, NCQA, Microsoft Office, Patient Confidentiality, Lean Principles

Industry

Hospitals and Health Care

Description

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. Positions in this function are responsible for direction and guidance on clinical quality improvement and management programs including accreditation. Conducts clinical quality audits and may also be responsible for NCQA requirements. Responsible for the reporting and analysis of member care quality and for the development of plans and programs to support continuous quality improvement. You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: Review and audit contracted sub-delegates Assist with report preparation and records regarding work function activities and projects Supports Medical Management Initiatives with quality improvement. Included but not limited to these departments: case management, utilization management programs and Medical Director Initiatives) Participates in and represents the Clinical Quality Team by collaborating with internal business partners focusing on quality improvement Participates in or coordinates with other departmental projects as needed Education to staff or contracted entities as needed Performs other duties as assigned Professional Competencies: Working knowledge of health care delivery systems Working knowledge of PC applications including MS Office Suite.Ability to use written and oral communication skills Ability to read and interpret data Skill in writing clear, grammatically correct Easy to use instructional documentation Ability to identify learning needs, set goals and seek educational opportunities Ability to analyze problems and formulate appropriate plans, solutions, and courses of action Knowledge of age specific communication needs with the ability to listen actively and respond to internal and external customers in a timely, competent manner both verbally and nonverbally Ability to work with frequent interruptions Ability to establish and maintain cooperative working relationships with individuals at all levels of the organization and affiliates Ability to maintain confidentiality of patient and all related entity business matters of the organization and its partners Ability to manage detail and work with accuracy Ability to recognize and act appropriately in situations where patient care needs exceed scope of practice Skill in working with a team and the ability to collaborate on projects with colleagues Skill in working effectively under deadlines and changing priorities Skills: All staff members are to promote a positive and productive work environment by acting maturely and responsibly, satisfactorily performing his or her job responsibilities and conducting themselves in a professional, courteous and respectful manner toward fellow employees, physicians and patients Must hold relationships to a high standard- respectful approach to all people and interactions, listening to understand, take emotional accountability and exemplify balance of self with all interactions, be receptive to feedback and opportunities keeping an open mind towards growth Integrates Lean principles, practices and tools to improve operational efficiency, reduce costs and increase customer satisfaction Follows written and oral instructions and completes routine tasks independently Completes annual compliance training on HIPAA/Privacy/Confidentiality/Non-Discrimination/Harassment/Integrity Statement and signed Agreements Ensures confidentiality of patient information following HIPAA guidelines and company policies Attends training to meet requirements of the job position and as needed or mandated by company policies and regulations Has regular and predictable attendance 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 5+ years of clinical experience 1+ years of experience working in managed care or in the insurance industry Experience with Medicare and/or Medicaid Knowledge base of clinical standards of care, preventive health standards, HEDIS, NCQA, governing and regulatory agency requirements Proficiency in software applications that include, but are not limited to, Microsoft Word, Microsoft Excel, Microsoft PowerPoint. Teams and Outlook Proven ability to evaluate medical records with attention to detail to perform quality audits Proven solid organizational skills, self-motivated and ability to interact with company staff at all levels Access to a safe quiet space to work as a telecommuter Preferred Qualifications: Subject matter expert for CMS 1+ years of clinical quality experience Experience with project coordination Demonstrated ability to assist with focusing activities toward a strategic direction as well as develop tactical plans, drive performance and achieve targets Demonstrated ability to do formal presentations in different settings- internal/external auditors, reporting on projects and reports that have been created and analyzed *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 $58,800 to $105,000 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.

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Responsibilities

The Clinical Quality Auditor is responsible for guiding clinical quality improvement programs and conducting quality audits. This role also involves reporting and analyzing member care quality to support continuous improvement initiatives.