Get introduced to vetted companies that are still hiring

Create a profile to become searchable by hiring managers.

9,230
JOBS
653
COMPANIES

Clinical Quality Analyst Senior - Remote - 2195050

Genoa Telepsychiatry

Genoa Telepsychiatry

IT, Quality Assurance
Eden Prairie, MN, USA
Posted on Wednesday, November 15, 2023

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. 

  • Generally, work is self-directed and not prescribed
    • Responsible for maintaining schedule
    • Responsible for prioritizing completion of audits within timeframes
    • Responsible for scheduling and booking travel
    • Responsible for development of findings from audits (includes audit reports and feedback letters)
  • Works with less structured, more complex issues
    • 75 percent travel
    • Responsible for completing a variety of site audits and treatment record reviews
    • Responsible for investigating quality of care concerns within network facilities and providers
    • Responsible for investigating Waste, Fraud, and Abuse concerns with practitioners
    • Responsible for investigating complaints about the physical environment of a provider’s office
  • Serves as a resource to others
    • Reports audit findings to requesting committees
    • Acts as a resource for Network Managers and Facility Contractors to regarding audits
    • Supports other auditors in completing audits within established guidelines
    • Serves as a resource to all types of providers regarding development of policies and procedure and maintenance of appropriate clinical documentation. This includes solo clinicians, groups, and facilities
    • Serves as a resource for risk management issues for all types of providers

If you are located in Minnesota, you will have the flexibility to work remotely* as you take on some tough challenges.

  

Primary Responsibilities: 

  • Assesses and interprets customer needs and requirements
    • Reviewing provider policies, procedures and documentation standards and identify areas of improvement, during initial and recredentialing audits
    • Providing feedback and recommendations on how to improve areas of deficiency related to provider deficiencies of policies, procedures, and documentation standards during initial and recredentialing audits
    • Interviewing and investigating quality of care (QOC) concerns and gaining an understanding of the underlying issues which may have caused the concern
    • Interpreting the information gathered during a QOC audit to develop reports to requesting committees, with recommendations of corrective action
    • reviewing progress notes against claims data for administrative audits (waste, fraud, and abuse audits), and identify whether the documented treatment is reflective of what was billed
    • Interpreting findings of administrative audits in report to various oversight committees, making recommendations of appropriate corrective actions, including referrals to Ingenix for further investigation
  • Identifies solutions to non-standard requests and problems
    • When completing quality of care audits or administrative audits, is responsible for developing the interviewing strategy prior to completion of the audit in order to answer the concerns related to the initial complaint
    • When completing quality of care audits or administrative audits, will conduct any needed research into issues that are being reviewed prior to audit (for example, what is allowed in a seclusion or restraint in a specific state)
    • When completing quality of care audits or administrative audits, is expected to adjust the investigation to follow pertinent facts or concerns as they arise in the investigation. This requires an ability to independently interpret the data at the audit and respond while at the audit
    • When documenting findings during quality of care audits or administrative audits, is expected to develop appropriate corrective action recommendations that address the identified concerns
  • Solves moderately complex problems and/or conducts moderately complex analyses
    • Completes increasingly complex site reviews of quality of concerns or potential billing concerns initially identified by various requesting committees
    • During the audit, must make independent decisions related to what is identified as a problem during the audit 
  • Works with minimal guidance; seeks guidance on only the most complex tasks
    • Is expected to operate independently
    • Is expected to organize their schedule and audit priorities
    • Is expected to be able to make decisions about how to proceed with audits when complications arise
    • Will contact management to consult in complex situations if needed
  • Provides explanations and information to others on difficult issues
    • Presents findings of quality of care concerns and administrative audits to other team members and committees
    • Must provide feedback to all types of providers about audit outcomes; when this feedback is poor (for example, a failing score), must present the feedback in a way that allows for collaboration to occur with the ultimate goal being to improve the quality of care available to our members
    • Assists in reviewing audit tools on an annual basis. During the year, will compile feedback from providers related to improvements to the audit tools. When new tools are implemented, will explain the changes and how these impact the providers
  • Coaches, provides feedback, and guides others
    • Mentors new auditors when they join the team
    • Participates in monthly meetings to serve as a resource to peers
    • Provides feedback, education and sample materials to all types of providers (individuals and facilities) related to the outcome of the audit and areas for improvement
    • Will work with providers to develop new forms and policies when needed
  • Acts as a resource for others with less experience
    • Provides field training of new staff
    • Provides information to other departments at their location regarding audit issues
  • Scope and Impact of Actions; Consequences of Mistakes
    • Audits that are completed as part of the credentialing process are required for credentialing to occur. NCQA requires accreditation of facilities. For those facilities without a national accreditation, the auditor completed an audit that is in place of national accreditation. If the audit is not completed in an accurate manner, an inadequate facility could be added to our network
    • Auditors work with all types of providers: solo clinicians, group practices, large community mental health centers, free standing hospitals and programs, small hospitals, and large hospital systems. This includes presentations to large management groups at hospital systems
    • Auditors are often the face of the company – sometimes the only person from the company the provider has met
    • Audit activities support all CACs for NCQA accreditation. The data is reported to these sites quarterly

  

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: 

  • Independently licensed clinician (able to bill for services)
  • 2+ years of experience in Behavioral Health
  • Must reside in the Greater Minneapolis, MN area

 

*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