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UnitedHealth Group Peoples Health Quality Nurse Auditor - LPN - Metairie, LA in Metairie, Louisiana

Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.

The Peoples Health Quality Nurse Auditor is responsible for receiving, extracting, reviewing, and documenting clinical information from a Member’s medical record that supports the Quality Improvement / HEDIS / Stars Division measures and goals. The Auditor utilizes clinical knowledge and technical specifications review documentation and files from medical records that align with CMS, and other governing agency, clinical quality metrics. The staff nurse is responsibility for ensuring and maintaining the mission of Peoples Health as outlined in the Mission Statement.

Primary Responsibilities:

  • Improve health care quality and increase likelihood of desired health outcomes

  • Monitor performance against assigned member’s gaps in HEDIS and Star measures through weekly report analysis

  • Contact provider offices to obtain necessary medical records to identify and close member gaps in care

  • Implement interventions designed to improve health outcomes specific to measures and quality improvement projects

  • Retrieve data from audits; review and update compliance with HEDIS and CMS metrics within the Member file

  • Perform provider and / or facility surveys and audits to review medical records and update Member file

  • Prepare quality documentation of requests and determinations that may ultimately prevent hospital readmission including but not limited too

  • Record review to ensure medication reconciliation is timely

  • Record review to ensure PCP has been notified timely of admission and discharge information

  • Implement activities to improve patient safety and reduce medical errors

  • Participate in provider office site reviews to ensure facility meets safety and quality standards

  • Review medical record documentation to ensure compliance with evidence - based clinical practice guidelines

  • Report any issues identified through medical record review to QI Director and Quality Referral Nurse

  • Provide and support wellness and health promotion activities

  • Interact with the member and the multidisciplinary team to establish measurable health care goals and prioritization of the member’s needs

  • Support health information technology (HIT) in health care quality improvement

  • Work in coordination company - based security health information systems technology to ensure appropriate documentation of the member’s care coordination and record

  • Participate in ongoing training to ensure the records are accurate and secure

  • Follow corporate instruction based on Federal and State guidance related to health information documentation and security

  • Work within company and program standards and timelines

Required Qualifications:

  • High School Diploma / GED (or higher)

  • Current, unrestricted LPN License in the State of LA

  • Experience in clinical or similar setting

  • Experience with clinical documentation systems

  • Ability to travel between office and other assigned locations on an intermittent basis (rare instances)

  • Experience with Excel to create, edit, and filter spreadsheets

Preferred Qualifications:

  • Chart audit experience

  • Disease management, chronic care improvement, and / or quality improvement experience in a managed care setting

  • Experience in managed care industry setting

  • Understanding of HMO and third - party administration

  • Understanding of nursing home and long term acute care regulations

Careers at UnitedHealthcare Medicare & Retirement. The Boomer generation is the fastest growing market segment in healthcare. And we are the largest business in the nation dedicated to serving their unique health and well - being needs. Up for the challenge of a lifetime? Join a team of the best and the brightest to find bold new ways to proactively improve the health and quality of life of these 9 million customers. You'll find a wealth of dynamic opportunities to grow and develop as we work together to heal and strengthen our Healthcare system. Ready? It's time to do your life’s best work.SM

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.

Keywords Peoples Health; Metairie, LA; UHG, UHC, M&R, Quality Nurse Auditor, LPN, licensed practical nurse, clinical setting, clinical documentation, chart audit, disease management, chronic care improvement, managed care