Remote Quality Nurse Auditor (LPN, LVN) – Louisiana

Job Overview

  • Clinical License LPN, LVN
  • State(s) LA


Compassion. It’s the starting point for health care providers like you and it’s what drives us every day as we put our exceptional skills together with a real feeling of caring for others. This is a place where your impact goes beyond providing care one patient at a time. Because here, every day, you’re also providing leadership and contributing in ways that can affect millions for years to come. Ready for a new path? Learn more, and start doing your life’s best work.SM


The Quality Nurse Auditor is responsible for receiving, extracting, reviewing, and documenting clinical information from a Member’s medical record that supports the Quality Improvement/ HEDIS/Stars Division measures and goals.


The Auditor utilizes clinical knowledge and technical specifications review documentation and files from medical records that align with CMS, and other governing agency, clinical quality metrics. The staff nurse is responsibility for ensuring and maintaining the mission of Peoples Health as outlined in the Mission Statement.


You’ll enjoy the flexibility to telecommute* from within the state of Louisiana as you take on some tough challenges.


Principal Responsibilities:

  • Improve health care quality and increase likelihood of desired health outcomes
    • Monitors performance against assigned member’s gaps in HEDIS and Star measures through weekly report analysis.
    • Contacts provider offices to obtain necessary medical records to identify and close member gaps in care
    • Implements interventions designed to improve health outcomes specific to measures and quality improvement projects.
    • Retrieves data from audits; reviews and updates compliance with HEDIS and CMS metrics within the Member file.
    • Performs provider and/or facility surveys and audits to review medical records and update Member file.
  • Prevent hospital readmission
    • Prepares quality documentation of requests and determinations that may ultimately prevent hospital readmission including but not limited too
    • Record review to ensure medication reconciliation is timely
    • Record review to ensure PCP has been notified timely of admission and discharge information
  • Implement activities to improve patient safety and reduce medical errors
    • Participates in provider office site reviews to ensure facility meets safety and quality standards
    • Reviews medical record documentation to ensure compliance with evidence- based clinical practice guidelines
    • Reports any issues identified through medical record review to QI Director and Quality Referral Nurse
  • Provide and support wellness and health promotion activities
    • Interacts with the member and the multidisciplinary team to establish measurable health care goals and prioritization of the member’s needs.
  • Support health information technology (HIT) in health care quality improvement
    • Works in coordination company-based security health information systems technology to ensure appropriate documentation of the member’s care coordination and record.
    • Participates in ongoing training to ensure the records are accurate and secure.
    • Follows corporate instruction based on Federal and State guidance related to health information documentation and security.
  • Other
    • Works within company and program standards and timelines

Peoples Health Competencies:

  • Commitment: to our Members: We have the power to change our member’s lives by placing them at the center of everything we do daily.
  • Action: By working together and delivering quality service, we enhance the lives of our members through dedication and teamwork.
  • Responsibility: To continue to strive to be the best for our members by adapting and evolving to change, continuing professional development, and to never stop learning.
  • Excellence: By exceeding expectations and finding innovative ways to exceed standards, we are changing our members’ lives.

Core Competencies

Ability to:

  • access clinical data and draw conclusions
  • think critically
  • influence and effect change utilizing negotiation, conflict management and resolution skills
  • interview, assess and develop effective individualized care plans
  • utilize effective means of both oral and written communication in order to gain members’ comprehension of encounter
  • utilize sound clinical judgement, assessment, planning and care coordination skills
  • be professional by being prompt, dependable and prepared
  • be a team player and to collaborate and work effectively with team members by displaying a helpful, pleasant and positive attitude and a willingness to adapt to change
  • comprehend and adhere to policies and procedures
  • utilize time management skills efficiently and effectively in order to handle multiple demands of diverse workload, organize and prioritize critical issues in order to meet daily deadlines
  • read, comprehend both written and oral communications and apply the information at hand
  • work independently and pro-actively and carry-out assignments to completion with minimum assistance
  • perform accurate work with a strong attention to detail
  • appreciate the diversity of work styles
  • display a high level of integrity and respect for confidentiality and adhere to regulatory and PH policies and procedures


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:

  • High School Diploma or GED
  • Licensed Practical Nurse in the state of LA
  • 3 years’ experience in clinical or similar setting
  • 3 years’ experience with clinical documentation systems
  • 2 years’ experience working within STAR program and closing HEDIS gaps in care
  • Advanced proficiency in in MS Suite; Excel, Word and Outlook


Preferred Qualifications:

  • Previous experience supporting health information technology (HIT) in health care quality improvement
  • Previous experience retrieving data from audits, while reviewing and updating compliance with HEDIS and CMS metrics within a Member file


UnitedHealth Group is an essential business. The health and safety of our team members is our highest priority, so we are taking a science driven approach to slowly welcome and transition some of our workforce back to the office with many safety protocols in place. We continue to monitor and assess before we confirm the return of each wave, paying specific attention to geography-specific trends. At this time, 90% of our non-clinical workforce transitioned to a work at home (remote) status.  We have taken steps to ensure the safety of our 325,000 team members and their families, providing them with resources and support as they continue to serve the members, patients and customers who depend on us.


You can learn more about all we are doing to fight COVID-19 and support impacted communities at: click here.


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


Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and 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.

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