Frail Elderly Waiver Auditor - Remote in MA

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.

The Frail Elder Waiver (FEW) Auditor is responsible for conducting onsite visits for both newly contracted and existing providers delivering Frail Elder Waiver services to our SCO enrollees. This role includes tracking, scheduling, and completing audits within six months of a provider joining the network, as well as performing annual onsite audits. The auditor will document findings and report them to relevant stakeholders.

Key responsibilities include overseeing the annual Frail Elder Waiver Attestation Audit and managing the process, documentation, and onsite audit requirements for all contracted Home and Community-Based Services (HCBS) provider types. The Field-Based Compliance Auditor ensures adherence to all applicable state and federal compliance regulations, internal policies, and contractual obligations.

This is a full-time position (40 hours/week), Monday through Friday. Employees must be flexible to work any 8-hour shift within our standard business hours of 8:30 AM to 5:00 PM. Occasional overtime may be required based on business needs. This role is primarily remote but includes on-site visits to provider locations.

If you are located in MA, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• Schedule audits to comply with 6 months and annual requirement audit
  
  
  
  • Audit Execution:
    
    
    
    • Conduct audits based on the established schedule, including a review of compliance with network requirements and standards.
    • Document audit findings and report them to relevant stakeholders.
    • Address any issues identified during the audit promptly to ensure compliance.
    
    
    
    
  • Continuous Improvement by Periodically reviewing the audit process to identify areas for improvement.
  
  
  
  

• Performance Metrics and Regulatory Submission
  
  
  
  • Performance Metrics:
    
    
    
    • Develop and maintain a set of performance metrics to evaluate the effectiveness and efficiency of the audit process.
    • Track key performance indicators (KPIs) such as audit completion rates, compliance rates, and issue resolution times.
    • Regularly review and update performance metrics to ensure alignment with organizational goals and regulatory requirements.
    
    
    
    
  • Workbook for State Regulator Submission:
    
    
    
    • Update the audit workbook with the latest performance metrics and audit findings for submission to the state regulator.
    • Ensure that all required data and documentation are accurately recorded and compiled in the workbook.
    • Collaborate with the compliance and regulatory teams to ensure timely and accurate submission of the workbook to the state regulator.
    
    
    
    
  
  
  
  

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 / GED OR equivalent work experience
• Must be 18 years of age OR older
• 2 + years of experience in healthcare auditing, compliance, or a related field in Manage Care
• Experience with reviewing and interpreting contract language
• Intermediate skills with Microsoft Excel (create, edit, sort, filter)
• Experience with communicating and engaging with Senior Leadership and high-level stakeholders
• Must be able to travel 50% of the time within the state of Massachusetts
• Ability to work any 8-hour shift within our standard business hours of 8:30 AM to 5:00 PM. Occasional overtime may be required based on business needs. This role is primarily remote but includes on-site visits to provider locations

Preferred Qualifications:

• 1+ years project management experience
• Knowledge of Medicaid/Medicare adherence methodologies
• Experience with state regulation

Telecommuting Requirements:

• Reside within MA
• Ability to keep all company sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

Soft Skills:

• Strong analytical and problem-solving skills
• Excellent organizational and time management abilities
• Effective communication and interpersonal skills
• Proficiency in Microsoft Office Suite and audit tracking systems

*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 salary for this role will range from $58,800 - $105,000 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.

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