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Senior Clinical Quality Analyst - New York City - Full-time / Part-time
| Hours | Full-time, Part-time |
|---|---|
| Location | New York, NY New York, New York |
About this job
New York HARP! Clinical License Required!
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 and help people live healthier lives while doing your life's best work.(sm)
Projected start date is May 18th. This position is a telecommute (work from home) position and will require travel in an assigned territory (initially the 5 boroughs) to conduct provider audits, with possible overnight stays required. The work schedule is Monday - Friday daytime hours with no on call required. This position focuses on NY HARP business.
If you're a motivated professional who's searching for a new way to use your behavioral health expertise, we encourage you to apply for this high-visibility position in our Operations division. As our Senior Clinical Quality Analyst, you would travel across the state of New York (5 boroughs) ensuring the highest quality performance from our dedicated staff. You would also gain exposure throughout our organization, and have a chance to advance into a variety of different areas.
Primary responsibilities:
- Reviewing provider policies, procedures and documentation standards and identify areas of improvement, during initial and re-credentialing audits.
- Traveling to conduct on-site provider audits throughout New York (5 boroughs).
- Responsible for providing feedback and recommendations on how to improve areas of deficiency related to provider deficiencies of policies, procedures, and documentation standards during initial and re-credentialing audits.
- Interviewing and investigating quality of care (QOC) concerns, and gaining an understanding of the underlying issues which may have caused the concern.
- Interpreting the information gathered during a QOC audit to develop reports to requesting committees, with recommendations of corrective action.
- Conduct ongoing audits to fulfill contractual requirements.
- Responsible for developing the interviewing strategy prior to completion of the audit in order to answer the concerns related to the initial complaint.
- Scoring audits and writing audit reports
- Working to ensure our members receive the best possible treatment from a network of high-quality providers
Requirements
Requirements:
- Master's Degree level clinician with an Independent Licensure in the Behavioral Health field (i.e. LCSW, LMFT, LPC) OR a Licensed PhD or PsyD Psychologist
- BSN level RN with 2 years of experience in behavioral health will also be considered
- Clinical License must be current and unrestricted for the State of New York
- Clinicians must have a minimum of 2 years of experience in behavioral health
- Computer proficiency, must be able to type and navigate a Windows based environment
- Must be able to travel within the 5 boroughs, in addition to occasional overnights as needed
Additional nice to have assets include:
- Quality improvement knowledge
- Familiarity with standards for NCQA and The Joint Commission
- Experience in managed care
- Hospital and Outpatient experience
- Utilization Management experience is a plus!
- Experience with chart auditing or chart review
- CPHQ certification is a plus!
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
Diversity creates a healthier atmosphere: 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: Clinical, Quality, Auditing, NCQA, Behavioral Health, Mental Health, RN, Nurse, Psychiatric, Social Worker, Psychologist, Therapist, Counselor, LCSW, LMFT, LPC, PhD, PsyD, Independent Licensure, burrows, NYC, NY, New York, New York City, UHG, UnitedHealth Group, Collaborative Care, Optum, Harp, New York Harp