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Remote in Arizona only. This position requires travel within the State of Arizona up to 50% of the time to provider offices and to the local UHC office for meetings.

General Job Profile

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  This position will be responsible for the gathering and auditing of medical records from contracted medical providers
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  Analyze track and report results. Recommend, develop, and implement quality improvement plans with providers and follow up as necessary

If you are located within Arizona, you will have the flexibility to telecommute* as you take on some tough challenges. Travel required locally up to 50%.

Primary Responsibilities:

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  Review, audit and Evaluate documentation of medical record
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  Review/interpret medical records/data to determine whether there is documentation reflected accurately in medical record
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  Follow relevant regulatory guidelines, policies and procedures in reviewing clinical documentation
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  Prioritize providers for medical chart review according to collaboration with other Health Plans
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  Identify incomplete/inconsistent information in medical records and label missing measures/metrics/concerns
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  Review relevant tool specifications to guide chart review
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  Review/interpret/summarize medical records/data to address any quality of care questions
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  Verify necessary documentation is included in medical records
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  Maintain HIPAA requirements for sharing minimum necessary information
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  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
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  Refer issues identified to relevant parties (e.g., review committee, Case Management, Medical Directors) for further review/action
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  Talk to provider offices to address and request corrective action plans
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  Educate provider representatives/office staff to address/improve auditing processes
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  Educate providers on proper medical record documentation for regulatory compliance
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  Educate providers offices on specifications/measures
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  Explain/convey technical specifications regarding action plans/follow up
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  Explain how provider scores are calculated/determined
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  Demonstrate knowledge of Medicaid benefit products including applicable state regulations
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  Demonstrate knowledge of applicable area of specialization (e.g., OBGYN, Family Practice, Pediatrics, community based services)
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  Demonstrate knowledge of computer functionality, navigation, and software applications (e.g., Windows, Microsoft Office applications, phone applications, fax server)
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  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

Daily Practices:

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  Solid verbal and written communication skills
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  Ability to work independently
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  Organizational Skills

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:

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  High School Diploma/GED
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  Licensed Practical Nurse (LPN) in the state of Arizona
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  2+ years medical chart audit experience including State Regulatory, HEDIS, Joint Commission
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  2+ years of Clinical Experience with Auditing
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  2+ years of experience with Microsoft Office; Word, Excel, Outlook and Teams
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  Ability to travel 50% of the time to provider offices
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  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:

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  2+ years of experience with a health plan
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  2+ years of experience with a regulatory contract

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 may result in rescission of an employment offer or termination of employment

Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.(sm)

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  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.