LTSS Auditor, RN - Remote in Michigan

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. We are currently seeking experienced professionals with LTSS or HCBS background and solid interpersonal skills to join our team. The LTSS Auditor will be responsible for ensuring LTSS members receive appropriate care in the least restrictive setting possible. If you are located in Michigan, you will have the flexibility to work remotely* as you take on some tough challenges. This is a work from home / telecommute position. Candidates must be able to work Monday - Friday from 8:00 am - 5:00 pm EST. Primary Responsibilities:

• Reviewing and evaluating assessments, care plans, and other documentation to determine if the individual meets the specific LTSS or HCBS waiver eligibility criteria
• Assessing the members’ needs to ensure that the proposed services and support are medically necessary and appropriately aligned with their person-centered plan of care
• Ensuring compliance with relevant federal and state regulations, clinical guidelines, and quality standards for LTSS/HCBS programs
• Collaborating with other healthcare professionals, such as case managers, physicians, and nurses, to gather necessary information and clarify documentation
• Making recommendations for approval or denial of LTSS and HCBS waiver services based on their clinical review
• Participating in quality assurance activities and identifying areas for improvement in service delivery and documentation practices
• Maintaining up-to-date knowledge of regulations, policies, and best practice

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:

• Independent and unrestricted RN license in the state of Michigan
• 3+ years of Managed Care Experience with LTSS focus
• 2+ years working with the HCBS waiver and LTSS/Personal Care
• Relevant clinical experience, often in areas such as long-term care, community mental health, developmental disabilities, or other specialized populations served by HCBS waivers
• Proficient computer and typing skills (MS Word and Outlook)
• Proven solid analytical, critical thinking, organizational and communication skills (both written and verbal)
• Access to high-speed internet at your home
• Resident of Michigan
• Ability to work Monday - Friday, 8am-5pm EST
• Driver's License and access to a reliable transportation

Preferred Qualification:

• Knowledge of LTSS and state appeals guidelines
• All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. 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. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable. 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. UnitedHealth Group 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. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Apply tot his job Apply To this Job