Senior Clinical Quality Auditor - Behavioral Health

Senior Clinical Quality Auditor

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.

Primary 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

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.

Required Qualifications:

• 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

Preferred Qualifications:

• 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

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 salary for this role will range from $72,800 to $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. 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.