Remote Manager Clinical Quality Consultants – IN or OH

Optum

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Requisition Number: 2209204
Job Category: Medical & Clinical Operations
Primary Location: Indianapolis, IN
(Remote considered)

For those who want to invent the future of health care, here’s your opportunity. We’re going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together. 

 

The Manager of Clinical Quality Consultants provides strategic leadership and direction for the quality improvement program to the local market. The Manager of Clinical Quality Consultants works within highly matrixed relationships to develop and operationalize the overall quality strategy for the assigned market ensuring the quality program is proactive, continuously improving to include quality management/improvement and regulatory adherence. This position provides insight and direction to the Regional Director of Quality Operations and assigned market to align with a changing healthcare landscape as it applies to quality.

 

He/she is responsible for driving and executing strategy to ensure optimal HEDIS/CMS Star results. Responsibilities including but not limited to HEDIS, CAHPS, HOS Standards, and Quality initiatives related to appropriate coding, driving deployment and relentless day to day operational monitoring of region/market as applicable.  The improvements will drive increased HEDIS/Star Ratings.  This includes partnering closely with the Regional Director of Quality Operations, VP Quality and Risk, Medical Director, and local market Cross functional leadership.

 

The Manager of Clinical Quality Consultants is the population health expert for the assigned market and assesses gaps in programs and disparities, proactively communicating the needs and driving innovation to find programs to work at the local or market level.  The Manager understands and influences Member and Provider Engagement Programs deployed in the market and assures day to day oversight to close member gaps in care.

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

Primary Responsibilities: 

  • Drives programs and initiatives to assure member access to care and gaps in care closure
  • Partners with Regional Director of Quality Operations, VP of Quality and Risk, Medical Director, and local market Cross functional leadership to ensure established quality goals are met
  • Manages assigned market/state Quality Improvement goals to drive and track data capture and collection, provider engagement and value-based contracting, member engagement programs, clinical, and customer care touch points
  • Aligns and coordinates deliverables within their market/region and among the team including but not limited to:  CMS Star program, HEDIS data collection, Data Analytics and Reporting, CAHPS Member Surveys, HOS member surveys, ICD10/CPT/CPT II coding capture related to Quality initiatives, and Regulatory Adherence, and Member/Provider Engagement
  • Display innovative problem solving and upholds principles of continuous quality improvement
  • Meet annual goals and objectives for the market and key metrics in conjunction & under the direction of the Regional Director of Quality Operations, cross functional teams and corporate goals and strategies to meet and exceed established program objectives
  • Monitors daily, weekly, monthly, quarterly, semi-annual, and annual reports against goals to assess program success and alignment and to identify opportunities for improvement
  • Accountable for and assists with Quality Strategy Business Plan
  • Accountability for and knowledge of the Quality Improvement, CMS/Star Rating information and updates, NCQA/HEDIS, and gap metrics for assigned market
  • Appropriate application to form strategy to drive the market to excellence
  • Performs all other related duties as assigned

 

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.

Years of post-high school education can be substituted/is equivalent to years of experience.

Required Qualifications: 

  • 5+ years of significant and progressive leadership or managerial experience and responsibilities. Management of process or discreet work stream is acceptable
  • 5+ years of experience in, and/or knowledge of, Clinical Quality and Quality Improvement processes
  • 3+ years of management experience
  • Proven excellent interpersonal skills
  • Demonstrated superior verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others
  • Proven problem-solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action
  • Ability to be performance driven
  • Exceptional analytical and data representation expertise
  • Demonstrated advanced knowledge of Microsoft Office applications, including, but not limited to, Word, Excel, Visio, and PowerPoint
  • Demonstrated experience with decision-making. Experience should include in-depth, hands-on exposure in dealing with multiple constituents and customers
  • Demonstrated success working in dynamic, fast-paced environment. Ability to effectively interface with teammates and management. Consistently exhibits behavior and communication skills that demonstrate the organization’s commitment to superior customer service, including quality, care and concern with all internal and external customers

Preferred Qualifications:

  • Clinical Registered Nurse or other related clinical experience
  • NCQA/HEDIS, CMS Star Program, ICD10/CPT/CPT II coding and CAHPS/HOS
  • Demonstrated solid knowledge base of clinical standards of care, preventative health, and STAR measures
  • Project management experience
  • Demonstrated solid financial analytical background within Medicare Advantage plans (Risk Adjustment/STARS Calculation models)

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

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.