Senior RN Clinical Quality Auditor - Remote

UnitedHealth Group•Nashville, TN

2h•$72,800 - $130,000•Remote

About The Position

The Senior Clinical Quality Auditor will be responsible for supporting care management products and operations reporting to the Manager of Quality for UMR. You will provide general support in reviewing and researching program processes for overall staff compliance. In addition to fostering teamwork and collaboration, much of your work will involve review of calls and documentation of elements of the call. Solid auditing skills are essential. You will also need effective communication skills, and the ability to effectively collaborate with your team members. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Requirements

Current, unrestricted RN license in state of residence
3+ years of proven experience in health plan quality improvement identifying areas of opportunity
Demonstrated experience auditing clinical programs in a managed care setting
Intermediate proficiency with Microsoft Word, Excel and PowerPoint

Nice To Haves

Experience working for UMR
Solid interpersonal skills and high level of professionalism
Excellent problem-solving skills with strong attention to detail
Excellent written and verbal communication skills
Ability to work independently in a remote environment and deliver exceptional results
Excellent time management and work prioritization skills

Responsibilities

Participate in audit preparation, analysis and review complex business processes, systems, workflows, SOPs, policies and procedures to identify and document risks and trends that may be non-compliant with contracts and or statutory requirements
Monitor Program staff for compliance to established processes, policies, and guidelines; and identify opportunities to improve process performance
Implement and complete UMR UM and care management quality audits and provide and coaching to staff and program management based on evaluation results
Participate in effective analysis of audit results and identify trends impacting program compliance
Collaborate in the design, creation and implementation of quality improvement projects and initiatives
Utilize applicable systems/tools to maintain and document Quality metrics/outcomes
Participate in Inter-Rater Reliability sessions with internal stakeholders to ensure evaluation consistency
Other responsibilities as assigned