Optum ยท 1 day ago
Senior Clinical Quality Auditor RN
La Crosse, WI
Full-time
Hybrid
Mid, Senior Level
$73K/yr - $130K/yr
3+ years expOptum is a health services company focused on improving healthcare quality and member experience. The Clinical Quality Auditor is responsible for ensuring compliance and quality across case management and clinic operations, performing audits, analyzing quality metrics, and collaborating with stakeholders for continuous improvement.
EducationHealth CareMedicalPharmaceutical
Responsibilities
Perform audits on case management documentation, care coordination workflows, and clinical processes as defined by work instructions, quality manual, and policy
Verify adherence to organizational policies, regulatory guidelines, and accreditation standards
Collect quality data for reporting contractual and internal requests. Analyzes and interprets data to ensure standards are met and provides summary reports
Identify gaps and recommend corrective actions to maintain compliance and quality
Analyze quality metrics and key performance indicators (KPIs) across case, care, and clinic delivery
Prepare audit reports and present findings to leadership and operational teams
Collaborate with stakeholders to identify corrective actions and process improvements
Assist in developing and updating training materials to align with quality and compliance standards
Partner with CQPS, Program operations and Program clinical and administrative teams to identify opportunities for workflow optimization
Support initiatives aimed at improving member experience, reducing errors, and enhancing efficiency
Qualification
Required
Associates degree in Nursing program or Bachelors degree in Nursing degree
Current, unrestricted RN license in the state
Equivalent combination of education, experience and/or applicable military experience will be considered
3+ years of experience in RN practice case management, care coordination, or clinic operations
2+ years of quality management and improvement experience
2+ years of clinical audit experience
1+ years of experience analyzing data and writing reports
Intermediate computer skills including Microsoft Office Programs
Proven excellent written and verbal communication, telephone etiquette and interpersonal skills
Preferred
Knowledge of regulatory requirements (e.g., CMS, NCQA) and healthcare quality standards
Experience analyzing large sets of data and writing reports
Demonstration of strong organizational, multi-tasking, and time management skills
Proven strong judgment, problem solving, and decision-making skills
Proficiency in auditing tools & reports
All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Benefits
A comprehensive benefits package
Incentive and recognition programs
Equity stock purchase
401k contribution
Company
Optum
Optum is a healthcare company that provides pharmacy services, health care operations, and population health management. It is a sub-organization of UnitedHealth Group.
10001+ employees
H1B Sponsorship
Optum has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (648)
2024 (559)
2023 (620)
2022 (851)
2021 (593)
2020 (438)
Funding
Current Stage
Late StageLeadership Team
Daniel Castillo
Chief Executive Officer, Optum Care Delivery
J
Jay Green
Chief Financial Officer
Recent News
2025-11-29
2025-11-19
2025-11-07
Company data provided by crunchbase