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
Didn't find what you're looking for? Search again!
Loading more jobs...