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Role Description

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.

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

Primary Responsibilities:

• Audit & Compliance
  • 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
• Performance Monitoring
  • 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
• Training & Support
  • Assist in developing and updating training materials to align with quality and compliance standards
• Continuous Improvement
  • 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

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.

Qualifications

• Associates degree in Nursing program or Bachelor's degree in Nursing
• 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

Requirements

• 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

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution (all benefits are subject to eligibility requirements)

Application Deadline

This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

Company Description

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.

OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.