Sr. Clinical Auditor Field based – Eastern or Western Kentucky

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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

 

Talk about meaningful work. Talk about an important role. Let’s talk about your next career move. Delivering quality care starts with ensuring our processes and documentation standards are being met and kept at the highest level possible. This means working behind the scenes ensuring a member-centric approach to care. As a Senior Quality Analyst, you will monitor and support health plan quality improvement initiatives with particular emphasis on compliance with state and federal regulatory and accreditation requirements. You’ll act as a voice for our members, guiding the development of comprehensive care plans that will help others live healthier lives.

 

Optum Provider Performance is an integrated team serving all Optum businesses. We’re focused on improving the health of our members, enhancing our operational effectiveness and reinforcing brand and reputation for high – quality health plans. Join us and help guide our efforts to improve the patient experience. It takes passion, commitment, intense focus and the ability to contribute effectively in a highly collaborative team environment.

 

This is a work from home position with up to 75% travel (flexible schedule) within Eastern or Western Kentucky, including some overnights

 

If you are located in Eastern or Western Kentucky you will have the flexibility to work remotely* as you take on some tough challenges.

 

Primary Responsibilities: 

• Complete clinical audits and record reviews of behavioral health and substance use disorder providers in the State of Kentucky
• Provide education and support to providers regarding operational and treatment record documentation standards
• Conduct quality of care investigations of behavioral health and substance use disorder providers
• Provide analytical support and expertise when compiling report information
• Develop and implement effective analysis, research and evaluation in preparation for clinical monitoring audits activities
• Assume responsibility for inter – rater reliability of clinical audit activities
• Participate in departmental meetings and activities
• Travel 75% of work month, including some overnight travel 

 

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: 

• Active, unrestricted, independent mental health licensure (i.e., LCSW, LMFT, LPC or Ph.D) in Kentucky
• 3+ years post licensure experience in behavioral health setting
• Demonstrated intermediate computer skills (Microsoft Word, Excel, Outlook, and Internet) with the ability to navigate a Windows environment, including create, edit, save, and send documents using Microsoft Word
• Reside in Eastern or Western Kentucky
• Ability to travel up to 75% of the month (flexible schedule), including overnights, to client and/or patient sites within Eastern or Western Kentucky
• Access to high-speed internet and a dedicated, distraction-free workspace at home

 

Preferred Qualifications:

• Experience with conducting clinical audits of behavioral health/substance use disorder treatment records
• Experience with Medicaid service delivery
• Experience extracting data from SQL or Oracle environments
• Knowledge/experience with behavioral health evidence-based practices
• Knowledge of Joint Commission survey processes
• Knowledge of HEDIS Standards
• Ability to collect, analyze, and present data

 

The salary range for this role is $71,600 to $140,600 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

 

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.

 

 

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.