Senior Clinical Quality Auditor RN
About the position The Clinical Quality Auditor for Case, Care & Clinic Delivery is responsible for ensuring compliance, accuracy, and consistency across case management, care coordination, and clinic operations. This role supports organizational standards, regulatory requirements, internal protocols, ethical guidelines and quality improvement initiatives to enhance member experience and operational excellence. For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week. Schedule: Monday - Friday, flexible 8 hour shifts between 7:00 a.m. - 6:00 p.m. CST 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.
Responsibilities
- Perform audits on case management documentation, care coordination workflows, and clinical processes as defined by work instructions, quality manual, and policy
- Verify adherence to organizational policies, regulatory guidelines, and accreditation standards
- Collect quality data for reporting contractual and internal requests. Analyzes and interprets data to ensure standards are met and provides summary reports
- Identify gaps and recommend corrective actions to maintain compliance and quality
- Analyze quality metrics and key performance indicators (KPIs) across case, care, and clinic delivery
- Prepare audit reports and present findings to leadership and operational teams
- Collaborate with stakeholders to identify corrective actions and process improvements
- Assist in developing and updating training materials to align with quality and compliance standards
- Partner with CQPS, Program operations and Program clinical and administrative teams to identify opportunities for workflow optimization
- Support initiatives aimed at improving member experience, reducing errors, and enhancing efficiency
Requirements
- Associates degree in Nursing program or Bachelors degree in Nursing degree
- Current, unrestricted RN license in the state
- Equivalent combination of education, experience and/or applicable military experience will be considered
- 3+ years of experience in RN practice case management, care coordination, or clinic operations
- 2+ years of quality management and improvement experience
- 2+ years of clinical audit experience
- 1+ years of experience analyzing data and writing reports
- Intermediate computer skills including Microsoft Office Programs
- Proven excellent written and verbal communication, telephone etiquette and interpersonal skills
Nice-to-haves
- Knowledge of regulatory requirements (e.g., CMS, NCQA) and healthcare quality standards
- Experience analyzing large sets of data and writing reports
- Demonstration of strong organizational, multi-tasking, and time management skills
- Proven strong judgment, problem solving, and decision-making skills
- Proficiency in auditing tools & reports
- All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
Benefits
- In addition to your salary, we offer 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 us, you’ll find a far-reaching choice of benefits and incentives.
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