Remote Director, Quality Improvement – New Mexico

Requisition Number: 2186064
Job Category: Medical & Clinical Operations
Primary Location: Albuquerque, NM
(Remote considered)

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 Director, Quality Improvement is the primary health plan leader accountable for establishing and implementing an effective quality improvement program essential to meet NCQA as well as requirements of the state and CMS as well as providing oversight for the Critical Incidents team. Lines of business in New Mexico include Medicaid, Long Term Service Support, and Dual Special Needs Plan (DSNP).  This position will report directly to the Chief Medical Officer/ Medical Director.  Must be in New Mexico.

The Director must work to ensure compliance with state and federal requirements and performance against standardized metrics, including accreditation, Healthcare Effectiveness Data and Information Set (HEDIS), New Mexico Department of Medicaid/Human Services Department (HSD) and CMS Stars Quality Rating System, Consumer Assessment of Healthcare Providers and Systems (CAHPS) and other Quality measures.

The individual will interface regularly with individuals internal and external to our organization at all levels. This position coordinates across multiple functional areas including but not limited to: Clinical, Operations, Pharmacy, Behavioral Health, National teams, State Health Care Authority, CMS and competitor health plans.

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

Primary Responsibilities:

• Providing primary oversight for quality initiatives that meet contractual requirements
• Develop and manage the health plan’s portfolio of improvement projects, including ensuring impact at a population level and identifying and prioritizing initiatives to align with the New Mexico Department of Medicaid’s Quality Strategy
• Oversee health plan improvement teams and coordinate QI training for health plan staff
• Reinforce the application of QI tools and methods within health plan improvement projects and initiatives
• NCQA readiness, accreditation, and ongoing compliance with NCQA requirements
• Oversight of the MMP Critical Incidents team
• Establishing and implementing governance and oversight of health plan quality program, including coordination of committee structure described in the health plan quality improvement program and the QAPI
• Developing and implementing programs and processes to achieve HEDIS and state value-based purchasing program requirements
• Providing effective leadership and management oversight of direct reports and members of the quality team to build a high performing team
• Serve as primary liaison with United Health Care (UHC) National Quality Team, effectively leveraging and coordinating national quality team resources and initiatives with local health plan quality resources, initiatives and requirements
• Serve as a primary driver of Performance Improvement within the health plan, including committee oversight, work plans and annual evaluation
• Partner internally (to include HP executive leadership team and staff, QI Directors from other states and national quality teams) and externally (to include: the state, CMS, providers, and community-based organizations) as needed to improve quality across the plan

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:

• Bachelor’s degree
• Current unrestricted New Mexico licensed registered nurse, physician, or physician’s assistant or be certified as a Certified Professional in Health Care Quality (CPHQ) by the National Association for Health Care Quality (NAHQ), and/or Certified in Health Care Quality and Management (CHCQM) by the American Board of Quality Assurance and Utilization Review Providers prior to employment or within 6 months of the hire date
• 8+ years progressive experience in Quality Improvement within a health plan or provider organization
• 5+ years clinical or healthcare insurance industry experience, including a general knowledge of regulatory and compliance
• 5+ years of experience in a Manager/Director role with adaptable leadership skills with the ability to achieve results in a complex organization by aligning goals with employees that are not considered direct reports
• 5+ years of experience implementing effective HEDIS programs and NCQA accreditation
• 4+ years demonstrated management experience and leading teams to be high performing
• 3+ years of quality improvement/population health experience
• Experience managing and coordinating regulatory audits including documentation, onsite preparation, and responsive corrective action plans
• Experience creating presentations and working with data to formally present information to physicians, administrators, state regulator, other providers and community partners
• Experience and familiarity with audit processes to include External Quality Review Organizations (EQRO)
• Experience working on health equity through collaboration with community-based organizations, analyzing and using healthcare disparities data
• Knowledge of population and public health, in both rural and urban settings
• Knowledge of social determinants of health in rural and urban setting in the Southeast
• Reside in New Mexico or willing to relocate

Preferred Qualifications:

• Advanced degree Nursing or Public Health or Business
• Six Sigma Certification

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy