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 and help people live healthier lives while doing your life's best work.(sm) This position is a telecommute / work from home position and will require 75% travel in the state of Virginia and 25% telecommute from home to conduct provider audits, with possible overnight stays required. The work schedule is Monday-Friday daytime hours with no on call required. If you're a motivated professional who's searching for a new way to use your mental health expertise, we encourage you to apply for this high-visibility position in our Operations division. As our Clinical Quality Analyst, you would travel across the state of Virginia ensuring the highest quality performance from our dedicated staff. You would also gain exposure throughout our organization, and have a chance to advance into a variety of different areas. Primary Responsibilities: Reviewing provider policies, procedures and documentation standards and identify areas of improvement, during initial and re-credentialing audits Meet and work collaboratively with other Clinical Quality Analysts on the Provider Performance team on a regular basis Traveling to conduct on-site provider audits throughout Virginia Responsible for providing feedback and recommendations on how to improve areas of deficiency related to provider deficiencies of policies, procedures, and documentation standards during initial and re-credentialing audits Interviewing and investigating quality of care (QOC) concerns, and gaining an understanding of the underlying issues which may have caused the concern Interpreting the information gathered during a QOC audit to develop reports to requesting committees, with recommendations of corrective action Conduct ongoing audits to fulfill contractual requirements Responsible for developing the interviewing strategy prior to completion of the audit in order to answer the concerns related to the initial complaint Scoring audits and writing audit reports Working to ensure our members receive the best possible treatment from a network of high-quality providers
Required Qualifications: Master's degree with independent licensure in the Mental Health field such as: LIMHP, LP, or licensed PhD; OR RN license with experience in mental health 2+ years of experience in behavioral health Computer proficiency Access to reliable transportation that will enable you to travel to client and / or patient sites within a designated areaPreferred Qualifications: Quality improvement knowledge Familiarity with standards for NCQA and The Joint Commission Experience in managed care Hospital and Outpatient experience Background working as an Auditor, including chart audit experienceCareers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm) Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Job Keywords: RN, LIMHP, LP, PhD, LPC, independent licensure, quality improvement, NCQA, mco, managed care, auditor, chart audit, quality of care, telecommute, work from home, field, provider, hospital, outpatient, Virginia, VA
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.