UnitedHealth Group Manager Quality Assurance - Telecommute in Las Vegas, Nevada

Enterprise Clinical Performance is charged with effectively implementing, monitoring, and executing on government pay for performance programs with a special focus on Risk Adjustment and HEDIS. Clinical Performance processes on a national level by providing support in all markets served by OptumCare Care Delivery. This position will report into the Director of Compliance and Quality Assurance and will be responsible for the oversight, strategy and daily activities of the Quality Assurance Auditors. Will also assist with OptumCare Delivery's Internal Medicare Advantage Quality Review program, Vendor coding QA, second level review programs, and high level confidential audit projects as needed. This is a national role, requiring interaction with all markets and/or business units within Care Delivery and Care Services.

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

Primary Responsibilities:

Manage all aspects of the Quality Assurance Program on a national level:

  • Provides oversight and coordination of staff assignments for the Quality Assurance Auditors

  • Conducts technical training and onboarding of new employees

  • Schedules and completes weekly one-on-one meetings/coaching sessions with direct reports

  • Performs second level quality audits on Senior Auditors on a monthly basis

  • Clearly communicates goals, standards and needs of the department and organization

  • Ensures that Optum Policies and coding standards are consistently applied in all processes

  • Ensure that all Auditors meet education, quality and productivity standards

  • Provides input and feedback on employee performance and conducts counseling and disciplinary actions as necessary

  • Provides guidance and support related to CMS regulations and Optum Coding Guidelines

  • Seeks ways to improve operational efficiency and make process improvement recommendations

  • Must be able to drive Coding Compliance Initiatives across all markets within Care Delivery

  • Support efforts of Enterprise Clinical Performance in all other initiatives

Required Qualifications:

  • Bachelor’s degree preferred or equivalent work experience may be substituted

  • CPC, CCS or RHIT certification required

  • 7+ years’ experience ICD coding

  • 2+ years’ experience Management/Supervisory role

  • 4+ years’ experience in Risk Adjustment

  • 5+ years’ experience in an auditor role, such as vendor QA or coder QA, providing feedback of audit results

  • Expert knowledge of CMS Risk Adjustment and ICD coding requirements and regulations

  • Proficient knowledge of HEDIS/Stars

  • Experience with retrospective and concurrent chart review programs for Medicare Advantage Enrollees

  • Ability to work a flexible schedule to accommodate meetings in multiple time zones. Standard business hours. Monday – Friday 8am -5pm.

  • Ability to interact with multiple levels of management including, clients, vendors, and healthcare providers

  • Must be able to continuously meet the requirements for a telecommuter, i.e. live in a location that can receive a UnitedHealth Group approved high speed internet connection, have a secure designated office space to maintain PHI, meet or exceed all performance expectations

  • Up to 25% travel required ( local and national travel)

Preferred Qualifications:

  • 5+ years’ provider education/query experience

  • COE Senior Quality Assurance Auditor Experience

  • Demonstrated ability to exercise good judgment

  • Ability to prioritize tasks, multi-task, and solve problems under tight deadlines

  • Good written and oral communication and presentation skills and be able to communicate complex issues

  • Proficiency with Microsoft Office

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system 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

*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.

Job Keywords: CPC, CCS, CCS-P, RHIT, CRC, auditor, risk adjustment, HCC, HEDIS, STARS, Coder, UHG, Optum, Quality Assurance, Telecommute, remote