Senior Regulatory Adherence Coordinator – National Remote

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.  

This position is for a professional who consults on various processes and supports regulatory compliance via quality auditing. The Optum West Senior Regulatory Adherence Coordinator functions as a quality auditor who completes various audits of internal non-clinical documentation based on delegation and regulatory requirements. This role may support the provision of education and training related to audit findings and trends.  

You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Reviews medical management documentation to complete quality audits, identifying errors or missing information in documentation
• Investigates quality audit performance findings and/or problems, with some assistance from others
• Works within a specific knowledge area, including UM/CM regulatory and delegation requirements as outlined in internal resources
• Prioritizes and organizes own work to meet deadlines
• Performs routine or structured work
• Uses existing policies, procedures and facts to solve problems
• Participates in inter-rater reliability exercises to promote audit consistency
• Performs other duties as assigned

The information listed above is not comprehensive of all duties/responsibilities performed. This job description is not an employment agreement or contract. Management has the exclusive right to alter this job description at any time without notice. 

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:

• High School Diploma/GED (or higher)
• 2+ years of clinical experience  
• 1+ years of experience working in managed care or in the insurance industry  
• Ability to evaluate medical records with attention to detail to perform quality audits  

Preferred Qualifications: 

• 1+ years of clinical quality experience  
• Experience performing quality audits 
• Experience with Medicare and/or Medicaid  
• Knowledge base of clinical standards of care, preventive health standards, HEDIS, NCQA, governing and regulatory agency requirements  
• Strong organizational skills, self-motivated and ability to interact with company staff at all levels  

Professional Competencies: 

• Working knowledge of health care delivery systems
• Working knowledge of PC applications including MS Office Suite
• Ability to use written and oral communication skills
• Ability to read and interpret data and clinical documentation
• Strong writing skills to include clear, grammatically correct, easy to use instructional or informational documentation
• Ability to identify learning needs, set goals and seek educational opportunities
• Ability to analyze problems and formulate appropriate plans, solutions, and courses of action
• Knowledge of customer specific communication needs with the ability to listen actively and respond to internal and external customers in a timely, competent manner both verbally and nonverbally
• Ability to work with frequent interruptions
• Ability to establish and maintain cooperative working relationships with individuals at all levels of the organization and affiliates
• Ability to maintain confidentiality of patient and all related entity business matters of the organization and its partners
• Ability to manage detail and work with accuracy. Critical attention to detail is a required competency for this role
• Ability to recognize and act appropriately in situations where patient care needs exceed scope of practice
• Skill in working with a team and the ability to collaborate on projects with colleagues
• Skill in working effectively under deadlines and changing priorities

Skills:  

• All staff members are to promote a positive and productive work environment by acting maturely and responsibly, satisfactorily performing their job responsibilities and conducting themselves in a professional, courteous and respectful manner toward fellow employees, physicians and patients
• Must hold relationships to a high standard- respectful approach to all people and interactions, listening to understand, take emotional accountability and exemplify balance of self with all interactions, be receptive to feedback and opportunities keeping an open mind towards growth
• As applicable, integrates Lean principles, practices and tools to improve operational efficiency, reduce costs and increase customer satisfaction
• Follows written and oral instructions and completes routine tasks independently
• Completes annual compliance training as assigned by the Enterprise, which includes but is not limited to: HIPAA/Privacy/Confidentiality/Non-Discrimination/Harassment/Cultural Proficiency/Fraud Waste & Abuse
• Ensures confidentiality of patient information following HIPAA guidelines and company policies
• Attends training to meet requirements of the job position and as needed or mandated by company policies and regulations
• Has regular and predictable attendance

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

    

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you’ll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $20.00 to $35.72 per hour based on full-time employment. We comply with all minimum wage laws as applicable. 

    

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. 

    

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. 

     

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.

   

     

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

    

UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.

    

   

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