Senior Consultant Case Management Audit And Compliance – Telecommute

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that’s improving the lives of millions. Here, innovation isn’t about another gadget, it’s about making health care data available wherever and whenever people need it, safely and reliably. There’s no room for error. Join us and start doing your life’s best work.(sm)

The Sr. Consultant, Case Management Audit and Compliance will be a member of the OAS Provider Clinical team responsible to conduct audits, analyze data, and identify trends in performance of case management, utilization review and discharge planning processes to ensure compliance to regulatory standards and quality of work related to best practice implementation. This role is responsible to proactively identify opportunities for process changes, education, and training enhancements.

The ideal candidate must be passionate about improving care delivery and effective at working in a fast-paced, high-energy environment to support senior leaders (C-suite), providers, and business partners through reporting, root cause analysis, documentation, and recommendations.

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Perform audits within the scope of case management, utilization review, and discharge planning across all operations teams
• Test current compliance with defined processes and policies and identify variance through statistical sampling and observation
• Research / audit specific cases which have deviated from the defined workflow, document issues, impact and/or risk and recommend process and/or staffing changes that should occur or have occurred as a result
• Identify opportunities for workflow optimization, education, and training to improve efficiency and effectiveness, reduce risk of non-compliance, and improve quality
• Define and manage the creation of artifacts and / or deliverables that effectively summarize findings, support fact-based recommendations, and provide appropriate detail to substantiate conclusions
• Communicate and present key findings and opportunities for improvement to support senior leaders (C-suite), providers, and business partners
• Provide feedback regarding education and training needs and assist with developing / presenting training materials as needed
• Review, update and maintain case management policies, procedures and other documentation of operational processes and standard work
• Collaborate with cross-functional teams and serve as an information source when critical quality or compliance issues arise
• Work and communicate with both internal and external customers in a positive results-oriented manner
• Ensure company standards are maintained and product integrity is preserved
• Build and create project and program deliverables while managing complex work streams
• Perform other duties as be assigned (e.g., special projects)

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 be interested in.

Required Qualifications:

• Bachelor’s degree in nursing, healthcare administration, or similar
• 2+ years of experience in health care quality or process improvement to include quality / auditing for regulatory standards (e.g., federal, state, Joint Commission)
• Experience analyzing business processes and workflows
• Experience conducting audits using a defined tool from the client’s medical record
• Demonstrated analytical and critical thinking skills with the ability to solve complex problems
• Demonstrated ability to identify the cause of an issue, proactively recommend potential solutions to an issue, with analysis of benefits / risks of implementing one solution over
• Demonstrated ability to gather and analyze data from multiple sources
• Ability to travel up to 10% (internal meetings)
• Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation

Preferred Qualifications:

• Experience with data management tools and / or BI tools (e.g., Tableau, MicroStrategy)
• Experience with project turnaround/remediation
• Case management discharge planning and utilization review, including use of InterQual and / or MCG criteria sets
• Advanced Microsoft Office expertise, specifically Excel and PowerPoint
• Proven ability to proactively prevent or address issues with consistent follow-through
• Solid interpersonal, team, and conflict resolution skills
• Exceptional written and verbal communication skills
• Excellent time management, organizational, and prioritization skills
• Flexible team player, dedicated to contributing toward the desired outcome
• Ability to remain objective and not interject presumptions or assumptions about intent of the operator
• Ability to take initiative and work independently in a fast-paced environment
• Resident of any of the following cities: Boulder, CO; Colorado Springs, CO; Dallas, TX; Hartford, CT; Houston, TX; Minneapolis, MN; Nashville, TN; Phoenix, AZ; Pittsburgh, PA; St. Louis, MO; Tampa, FL

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement result in rescission of an employment offer or termination of employment.

Careers with Optum. Here’s the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world’s large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life’s best work.(sm)

Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $82,100 to $146,900. The salary range for Connecticut/Nevada residents is $90,500 to $161,600. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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.

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

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.