Behavioral Health, Quality Assurance - Telecommute in Colorado - 2019351

If you want to achieve more in your mission of health care, you have to be really smart about the business of health care. Challenge yourself, your peers and our industry by shaping what health care looks like and doing your life's best work.(sm)

Doing the right thing is a way of life at Rocky Mountain Health Plans (RMHP). As part of the UnitedHealthcare family of plans, RMHP provides innovative health insurance coverage and personalized attention to individuals of all ages and business of all sizes throughout Western and rural Colorado. RMHP is continually striving to improve the health and wellness of our Members and partners in the state where we live, work, and play – because we’re Colorado, too.

If you are located in Colorado, you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

Oversight of development and implementation of the Behavioral Health Compliance and Quality Assurance Program for Medicaid contracts

Developing performance improvement strategies for the Medicaid performance indicators

Provides support of Behavioral Health compliance policies and procedures that meet and exceed the contract requirements of the state

Conducts Quality of Care Reviews and Audits of Behavioral Health Network Providers in compliance with policy and procedures

Supports development of internal and external quality assurance policies and procedures aligned with the state Behavioral Health measures

Assures and oversees compliance and resolution of internal and external corrective action plans related to the Medicaid Behavioral Health network performance

Collaborates with the Chief Compliance Officer and others to develop and implement tactical plans for process improvement, problem identification, resolution, detailing goals, critical indicators, measures, financial and other resource requirements related to the role

Works in collaboration with the Quality Improvement, Utilization Management and Appeals and Grievances department to oversee the investigation and resolution of member complaints in accordance with policies and state requirements

Develops and implements an annual plan detailing the strategies, programs and tools

Assures compliance with corporate Performance Improvement work plans

Works with both internal and external customers to promote understanding of health services activities and objectives and to prioritize projects according to regional and state goals

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:

Bachelor’s degree

3+ years of related experience in quality assurance oversight

Ability to collect, analyze and present data

Preferred Qualifications:

BH Clinical License, LCSW, LPC, LMFT, or licensed Psychologist

UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.

Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low- income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.(sm)

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Colorado Residents Only: The salary range for Colorado residents is $64,800 to $116,000. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.