UM Delegation Oversight - Remote

UnitedHealth Group•Eden Prairie, MN

11d•$20 - $36•Remote

About The Position

Under the general direction of the Delegation Oversight Manager, this position is responsible for coordinating all components of Health Plan Delegation Oversight audits and performing internal quality reviews for Case Management and Utilization Management. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. Hours for the role are Monday through Friday 8AM-5PM.

Requirements

Graduation from an accredited Licensed Vocational/Practical Nurse program or completion of vocational nursing program through the CA Board of Nursing
Current LVN/LPN license
2+ years of clinical experience working as an LVN/LPN
1+ years of utilization management experience especially Prior Authorization

Nice To Haves

3+ years of experience working as an LVN/LPN
2+ years of care management, utilization review or discharge planning experience
Experience in an HMO or experience in a Managed Care setting
A base knowledge of requirements for Medicare, Medi-Cal and Commercial lines of business

Responsibilities

Prepares and submits of pre-audit documentation as outlined on Health Plan audit tools
Communicates with Health Plan auditors related to audit documents and processes
Communicates and collaborates across the organization to gather necessary documentation to meet audit requirements
Facilitate onsite/virtual/desktop compliance audit reviews to ascertain regulatory requirements adherence
Participates in performance improvement activities
Conduct comprehensive internal audit of the end-to-end utilization management process
Conduct focused internal audits of a specific element or process change based on identified trends or new process implementation