Senior Clinical Quality Auditor - Behavioral Health

UnitedHealth Group•Salt Lake City, UT

About The Position

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. For you, quality counts. For UnitedHealthcare, part of the UnitedHealth Group family of businesses, delivering quality care starts with processes and documentation standards that are the best in our industry. As a Senior Clinical Quality Auditor, you’ll be a force for positive change, guiding the development of comprehensive care plans that will help others live healthier lives. Join us and help guide our efforts to improve the patient experience. In addition to fostering teamwork and collaboration, much of your work will involve data analysis. Solid auditing skills are essential. You’ll also need the communication and persuasion skills to deal with clinical and non-clinical audiences. 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.

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 identifying data targets and analyzing results related to quality improvement/performance outcomes
Knowledge of the behavioral health services in Salt Lake and/or Tooele Counties
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 workspace and access to install secure high speed internet

Nice To Haves

Experience with quality measures such as HEDIS
Experience developing and implementing performance improvement projects or using data to develop intervention strategies to improve outcomes
Experience investigating quality of care concerns and critical incidents
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

Responsibilities

Complete treatment record review audits and provide feedback results
Implementing 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 conduct on-site audits for providers in Tooele and Salt Lake County 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