UnitedHealth Group Looking for Sr. Clinical Auditor – Field based – Eastern TN at Knoxville, TN  Full Time

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.

Talk about meaningful work. Talk about an important role. Let’s talk about your next career move. Delivering quality care starts with ensuring our processes and documentation standards are being met and kept at the highest level possible. This means working behind the scenes ensuring a member-centric approach to care. As a Senior Quality Analyst, you will monitor and support health plan quality improvement initiatives with particular emphasis on compliance with state and federal regulatory and accreditation requirements. You’ll act as a voice for our members, guiding the development of comprehensive care plans that will help others live healthier lives.

Optum Provider Performance is an integrated team serving all Optum businesses. We’re focused on improving the health of our members, enhancing our operational effectiveness and reinforcing brand and reputation for high – quality health plans. Join us and help guide our efforts to improve the patient experience. It takes passion, commitment, intense focus and the ability to contribute effectively in a highly collaborative team environment.

**This is a work from home position with up to 75% travel (flexible schedule) within Eastern Tennessee, including some overnights ***

If you are located in Eastern Tennessee, you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

• Complete clinical audits and record reviews of behavioral health and substance use disorder providers in the State of Tennessee
  
• Provide education and support to providers regarding operational and treatment record documentation standards
  
• Conduct quality of care investigations of behavioral health and substance use disorder providers
  
• Provide analytical support and expertise when compiling report information
  
• Develop and implement effective analysis, research and evaluation in preparation for clinical monitoring audits activities
  
• Assume responsibility for inter – rater reliability of clinical audit activities
  
• Extract appropriate data from SQL or Oracle environments
  
• Participate in departmental meetings and activities
  
• Travel 75% of work month, including some overnight travel

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.

One year of post-high school education can be substituted/is equivalent to one year of experience.

Required Qualifications:

• Active, unrestricted, independent mental health licensure (i.e., LCSW, LMFT, LPC or Ph.D) in Tennessee
  
• 3+ years post licensure experience in behavioral health setting
  
• Demonstrated intermediate computer skills (Microsoft Word, Excel, Outlook, and Internet) with the ability to navigate a Windows environment, including create, edit, save, and send documents using Microsoft Word
  
• Ability to collect, analyze, and present data
  
• Reside in Eastern Tennessee
  
• Ability to travel up to 75% of the month (flexible schedule), including overnights, to client and/or patient sites within Eastern Tennessee
  
• Access to high-speed internet and a dedicated, distraction-free workspace at home
  

Preferred Qualifications:

• Experience with conducting clinical audits of behavioral health/substance use disorder treatment records
  
• Experience with Medicaid service delivery
  
• Knowledge/experience with behavioral health evidence-based practices
  
• Knowledge of Joint Commission survey processes
  
• Knowledge of HEDIS Standards
  

*All employees working remotely 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 employers 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