Manager Clinical Quality - Telecommute in WI

Company: UnitedHealth Group
Location: Los Angeles
Posted on: June 25, 2022

Job Description:

UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm) As the Manager of Clinical Quality you will manage a team of Clinical Practice Consultants and be responsible for direction and guidance on clinical quality improvement and management programs including accreditation. Conduct clinical quality audits and may also be responsible for NCQA requirements. Responsible for the reporting and analysis of member care quality and for the development of plans and programs to support continuous quality improvement using HEDIS and other tools. If you are located in Milwaukee, WI, you will have the flexibility to telecommute* as you take on some tough challenges. Primary Responsibilities:

• Provide leadership to and accountable for performance of senior level professional staff
• Liaise or manage supporting business segments external to the department
• National Quality Management segments supporting the health plan
• Manage all department clinical quality improvement function including accreditation, provider profiling, Quality of care / service initiatives and the Clinical Practice Consultant program
• Supervision and oversight of credentialing functions necessary to support credentialing collaborative
• Implementation and approval of the Quality Improvement Program and Work plan, as well as development and approval of the annual Quality Improvement Program Evaluation
• Responsible for creation and delivery of regulator required reports and submissions, and ensuring compliance with all Quality Management requirements specified by regulator
• Direct Quality initiatives to improve member care and meet state regulatory requirements (including all locally / nationally initiated Quality Improvement projects, state-mandated Performance
• Improvement Projects), and selection of new improvement projects after conducting analyses, literature review, and / or other quality reviews (e.g. barrier analyses, focus groups, surveys) to identify opportunities to improve member care and quality metrics
• Participate in development, management and monitoring of national quality improvement projects
• Conduct clinical quality audits
• May be responsible for NCQA accreditation submission
• Responsible for oversight of reporting and analysis of member care quality, provider and member satisfaction, and access and availability
• Facilitates health plan quality committees, such as the Quality Management Committee and the Provider Affairs Subcommittee, and participates as appropriate national quality meetings
• Conducts clinical quality audits and may also be responsible for NCQA requirements
• Responsible for the reporting and analysis of member care quality and for the development of plans and programs to support continuous quality improvement using HEDIS and other tools 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:
  • Current, unrestricted RN license in WI
  • 3+ years of experience with demonstrated functional knowledge related to regulatory adherence of a quality management program (HEDIS, Accreditation, NCQA, Reporting, Committee Management)
  • 3+ years of quality improvement and / or provider experience
  • Expertise with HEDIS
  • Proficiency using a PC in a Windows environment, including Microsoft Word, Excel and PowerPoint
  • Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation Preferred Qualifications:
    • Bachelor's Degree
    • Certified Professional in Healthcare Quality (CPHQ) certification
    • Managed Care experience
    • Experience working in Medicaid and / or Medicare
    • Experience managing a virtual team
    • Highly preferred health care and insurance industry experience, including regulatory and compliance
    • Demonstrated leadership and team development skills To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.(sm) *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.

Keywords: UnitedHealth Group, Los Angeles , Manager Clinical Quality - Telecommute in WI, Healthcare , Los Angeles, California