Social Work Auditor 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.  

The Director of Social Work is responsible for successfully planning, organizing and directing Enterprise operations for outpatient Social Work and Behavioral Health within Care Management. The Director coordinates duties with appropriate personnel to meet operational program needs, ensures compliance with state and federal health plan requirements, Medicare guidelines and NCQA standards; develops and implements policy and procedures; updates and integrates current practice guidelines; performs employee counseling, performance appraisals, and oversights employee training and development.  The success of this position requires the ability to foster communication and teamwork between social worker teams, physicians and staff, market care management teams, corporate departments, vendors, and senior leadership. The position directs long-term planning and regarding Social Work and Behavioral Health and acts as a resource to all internal and external customers. This position is responsible for oversight and evaluation of all Care Management Social Work and Behavioral Health programs.  The Director will report to the Vice President of Care Management and will assist senior leadership with long-term planning initiatives to maintain operations assuring activities are appropriately integrated into strategic direction, as well as the mission and values of the company.  
 

Primary Responsibilities:

• Accountable for end-to-end social work/ behavioral health processes
• Oversees social work functions and ensures compliance with approved guidelines, government mandated regulations and contractual agreements to include NCQA, URAC and CMS
• Manages a team of Licensed Social Work/Behavioral Health Mangers providing direction to ensure effective management and support of SW/BH staff
• Develops functional, market level, and/or site strategy, plans, production and/or organizational priorities
• Identifies and resolves technical, operational and organizational problems outside their own team
• Responsible for product, service or process decisions likely to impact entire functions and/or customer accounts (internal or external)
• Provides leadership to and is accountable for the performance of managers and/or senior level professional staff
• Review and Implement Social Work protocols for staff oversight and development
• Leverage clinical acumen to provide guidance to staff
• Assist staff in navigating the medical management system
• Provide oversight and review of coordination of care
• Ensure employees are current with clinical licensure and certifications
• Develop/oversee/deliver operational or technical training
• Fosters leadership skills for supervisor positions to ensure aligned management of staff to include the development of future leadership candidates
• Plan, implement, and manage Social Work /Behavioral Health/Community Health worker programs.  
• Develop policies, procedures, and guidelines for program
• Review/approve policy and process changes
• Evaluate regulatory changes and determine steps needed to implement in program
• Identify and implement business development opportunities to support growth program
• Oversee/navigate technology applications utilized in the delivery of program
• Intervene in resolution of member or employee complaints or issues as necessary
• Create and implement a business continuity plan to minimize interruptions to the business
• Promotes communication to members by informing them of updates and revision in policies, using training or orientation opportunities, newsletters, or other available resources such as forum presentations
• Cultivates relationships with internal and external groups in support of member education and knowledge sharing
• Ensure compliance of Social Work Program and services
• Interpret compliance/clinical/medical reports
• Evaluate compliance with Federal, State, and Local regulatory and organizational guidelines
• Evaluate programs and services against accreditation standards and contractual requirements
• Oversee ongoing monitoring and internal auditing against relevant guidelines and standards Implement process improvement activities to address areas of non-compliance or ensure procedures are followed
• Measure employee/provider performance against internal procedures and protocols
• Ensure team members address gaps in performance against internal procedures and protocols
• Monitor and evaluate employee performance and productivity
• Develop operations program goals
• Develop and communicate performance metrics and expectations
• Direct data collection and measurement of outcomes
• Apply metrics to evaluate services, employee performance, and program outcomes
• Identify causes of performance deficiencies and determine appropriate follow up actions
• Drive implementation of best practices and standards
• Plan and manage operations to ensure financial viability
• Develop operational budgets for medical and clinical operations
• Evaluate staffing ratios, stratification of care, overtime, agency usage, or level of position to effectively manage labor expenses
• Read financial reports, identify reasons for financial performance gaps, and identify opportunities for improved financial performance and enhanced return on investment
• Collect and review data to evaluate financial outcomes of programs and services
• Conduct cost/benefit analysis on program to drive efficiencies and identify opportunities to enhance financial viability

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:

• Undergraduate degree in behavioral sciences; preferable a Bachelor's of Science in Social Work; 10 years of experience in social work with a minimum of 5 years at a management level
• Experience in contract language, claims, Utilization Management guidelines and accreditation guidelines
• Ability and willingness to travel both locally and non-locally as determined by business need
• Ability to travel up to 30% of the time

Preferred Qualifications:

• Master's Degree or Higher
• Active and unrestricted LCSW license in any US state
• Prior multi-site regional operations management responsibilities
• Experience with managed care

Physical & Mental Requirements:

• Ability to sit for extended periods of time
• Ability to stand for extended periods of time
• Ability to receive and comprehend instructions verbally and/or in writing
• Ability to use logical reasoning for simple and complex problem solving

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 salary for this role will range from $91,700 - $163,700 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.