Optum Quality Audit Jobs (NOW HIRING)

Explore opportunities with WellMed, part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will be part of a team who shares your passion for helping people achieve improved health outcomes. Explore rewarding opportunities for physicians, clinical staff and non-patient-facing roles. Join us and discover the meaning behind Caring. Connecting. Growing together.

Primary Responsibilities:

• Support contracted providers within the Houston market on quality and HEDIS initiatives
• Conduct provider and clinic education regarding quality measures and performance expectations
• Perform delegated oversight activities, audits, monitoring, and compliance reviews
• Analyze audit findings, identify trends and risks, and recommend corrective actions
• Lead provider-facing meetings and communicate performance results
• Support gap closure activities and quality improvement initiatives

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:

• Active, unrestricted RN license
• 5+ years of clinical nursing experience
• 2+ years of managed care experience supporting Commercial, Medicare, Medicaid, or SNP populations.
• Experience with audits, delegation oversight, utilization management, quality improvement, or clinical compliance activities
• Experience with quality reporting and audit documentation tools used within delegated oversight programs
• Solid understanding of CMS, NCQA, HEDIS, and regulatory/accreditation requirements
• Proficiency in Microsoft Outlook, Teams, Word, Excel, and PowerPoint
• Proficiency in Microsoft Copilot and general AI-enabled tools
• Proficiency in educating, influencing, and presenting to providers and clinic leadership
• Proven ability to navigate multiple EMR platforms used by provider groups
• Must reside in the Houston, TX market
• Willing and able to travel throughout the assigned market as needed
• Valid driver's license required, along with reliable transportation for local travel

Preferred Qualifications:

• Advanced degree(s)
• Experience navigating multiple EMR systems
• Experience with delegated oversight and accreditation environments
• Solid HEDIS knowledge and experience with quality metrics
• Experience working with CMS, NCQA, and managed care quality programs

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). The salary for this role will range from $72,800 - $130,000 annually 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.