Field LPN Auditor, Clinical Quality Management - Phoenix, AZ
Company: UnitedHealthcare
Location: Gilbert
Posted on: October 10, 2024
|
|
Job Description:
At UnitedHealthcare, we---re simplifying the health care
experience, creating healthier communities, and removing barriers
to quality care. The work you do here impacts the lives of millions
of people for the better. Come build the health care system of
tomorrow, making it more responsive, affordable, and equitable.
Ready to make a difference? Join us to start Caring. Connecting.
Growing together. This position will be responsible for the
gathering and auditing of medical records from contacted medical
providers. Analyze, track, and report results. Recommend, develop,
educate and implement quality improvement plans with providers and
follow up as necessary. If you reside in Phoenix, AZ, you will
enjoy the flexibility of a hybrid-remote role as you take on some
tough challenges. Must reside locally to Phoenix, AZ. Primary
Responsibilities: Review and audit Medicaid (AHCCCS) Electronic
Visit Verification (EVV) providers and medical records regarding
AHCCCS AMPM requirements around EVV Review, audit and evaluate
documentation of medical records Review/interpret medical
records/data to determine whether there is documentation reflected
accurately in medical record Follow relevant regulatory guidelines,
policies and procedures in reviewing clinical documentation
Prioritize providers for medical chart review according to
collaboration with other Health Plans Identify
incomplete/inconsistent information in medical records and label
missing measures/metrics/concerns Review relevant tool
specifications to guide chart review Review/interpret/summarize
medical records/data to address any quality of care questions
Verify necessary documentation is included in medical records
Maintain HIPAA requirements for sharing minimum necessary
information Based on review of clinical data/documentation,
identify potential quality of care issues (e.g., variations from
standard practice potentially resulting in adverse outcomes) and
potential fraud/waste/abuse Refer issues identified to relevant
parties (e.g., review committee, Case Management, Medical
Directors) for further review/action Discuss with provider offices
to address and request corrective action plans Educate provider
representatives/office staff to address/improve auditing processes
Educate providers on proper medical record documentation for
regulatory compliance Educate providers offices on
specifications/measures Explain/convey technical specifications
regarding action plans/follow up Explain how provider scores are
calculated/determined Demonstrate knowledge of public healthcare
insurance industry products(Medicaid Demonstrate knowledge of
Medicaid benefit products including applicable state regulations
Demonstrate knowledge of applicable area of specialization (e.g.,
community based services) Demonstrate knowledge of computer
functionality, navigation, and software applications (e.g.,
Windows, Microsoft Office applications, phone applications, fax
server) Demonstrate knowledge of specific software applications
associated with the job function (e.g., navigation of relevant
computer applications or systems, intranet databases, records
management or claims database Prepare for and participate in
meetings with State agencies, providers, and stakeholders as well
as internal meetings Assist with other quality management audits,
corrective action plans as needed This position will have on site
provider location visits throughout Arizona This position is a work
from home position with 50% in state travel What are the reasons to
consider working for UnitedHealth Group? Put it all together ---
competitive base pay, a full and comprehensive benefit program,
performance rewards, and a management team who demonstrates their
commitment to your success. Some of our offerings include: Paid
Time Off which you start to accrue with your first pay period plus
8 Paid Holidays Medical Plan options along with participation in a
Health Spending Account or a Health Saving account Dental, Vision,
Life& AD&D Insurance along with Short-term disability and
Long-Term Disability coverage 401(k) Savings Plan, Employee Stock
Purchase Plan Education Reimbursement Employee Discounts Employee
Assistance Program Employee Referral Bonus Program Voluntary
Benefits (pet insurance, legal insurance, LTC Insurance, etc.) More
information can be downloaded at: http://uhg.hr/uhgbenefits
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) Active and
unrestricted LPN license in the state of Arizona 3 years of
experience in the Medicaid health field including provider
interactions 2 years of experience reviewing medical record
charts/documentation and writing regulatory reports Intermediate
level of proficiency with software applications that include, but
are not limited to, Microsoft Word, Excel and Teams Reside in
Arizona Reliable transportation for field visits Ability to travel
50% for the position throughout Arizona when business requires All
Telecommuters will be required to adhere to UnitedHealth Group---s
Telecommuter Policy. 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. RPO, Red
Keywords: UnitedHealthcare, Tempe , Field LPN Auditor, Clinical Quality Management - Phoenix, AZ, Accounting, Auditing , Gilbert, Arizona
Click
here to apply!
|