Requisition Number: 2238579
Job Category: Medical & Clinical Operations
Primary Location: Atlanta, GA
(Remote considered)
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
Primary Responsibilities:
-Prep cases for audits or review activities to ensure quality
-Develop understanding of customer requirements and/or expectations and anticipate needs to determine appropriate course of action
-Develop audit or review processes (e.g., automated/technically driven)
-Review relevant agreements (e.g., contractual, intersegment) and obtain clarification as necessary
-Read and interpret standards/requirements and/or technical specifications (e.g., structure and process, CMS star ratings, , URAC, NCQA, Joint Commission, and SNP)
-Evaluate current processes, compare to relevant standards or specifications and identify gaps in compliance or performance
-Perform/participate in assessments of the audit or review (e.g., interrater reliability of audit findings across auditors)
-Work cross-functionally, making recommendations or clarifying information to assist in closing gaps that are identified or meeting customer expectations
-Work with auditors or key stakeholders for review/approval of results
-Develop and/or assist with corrective action plans based on audit findings or customer feedback
-Review processes and performance against customer expectations to provide needed information or service
-Conduct calibration audits and IRRs on quality auditors as needed
-Maintain updates to the quality audit tools, reference guides, and/or definition documents as needed for consistency with the most current process.
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:
- Current and unrestricted RN or compact RN license
- 2+ years of acute nursing experience or equivalent in managed care
- Demonstrated basic computer proficiency (i.e. MS Word, Outlook)
- Proven ability to function independently and responsibly with minimal supervision
*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
California, Colorado, Connecticut, Hawaii, Nevada, New York, New Jersey, Rhode Island, Washington or Washington, D.C. Residents Only: The salary range for this role is $70,200 to $137,800 annually. 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.
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.