Field LPN Auditor, Clinical Quality Management - Phoenix, AZ
Company: UnitedHealthcare
Location: Laveen
Posted on: October 11, 2024
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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: -
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.
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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.
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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. -
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#RPO, #Red
Keywords: UnitedHealthcare, Sun City , Field LPN Auditor, Clinical Quality Management - Phoenix, AZ, Executive , Laveen, Arizona
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