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 and help people live healthier lives while doing your life's best work.(sm) This position requires an experienced mid-market individual familiar with the general operations of a Medicaid and / or a Medicare plan, and some familiarity with quality management within a Medicaid / Medicare market. This position will be responsible for management of professional staff. The success of the quality program also depends upon teams outside of the department that support critical activities, and the ability to professionally communicate, influence and build relationships with departments and staff outside span of control within a shared services environment is critical to success In addition to leadership skills, a strong comfort with directing data acquisition is needed. Positions in this function are responsible for direction and guidance on clinical quality improvement and management programs. This position is responsible for managing quality improvement and quality management programs. This position may be responsible for reporting and analysis of quality performance measures, oversight of audits related to regulatory contractual requirements, development of plans and programs to support continuous quality improvement using HEDIS measures and other tools and creation and submission of annual and quarterly submissions to different state regulators. This position is located on-site at 1 East Washington Street in Phoenix, AZ Primary Responsibilities:Team Management: Manage staff within the quality management department, including employees who conduct provider- and member-focused interventions to meet Medicaid and Medicare quality performance goals Annual Regulatory Reporting: Responsible for design, implementation and approval of quality improvement programs and work plans, as well as development and approval of annual quality program evaluations Quarterly Regulator Reporting: Responsible for analysis, creation and delivery of quarterly regulatory reports and for ensuring compliance with all quality management requirements specified by regulator in policy or contract Quality Improvement Design: Responsible for selection and design of new improvement projects based upon analyses, literature review and other quality reviews to improve member care Quality Improvement Interventions: Responsible for maintaining or improving performance upon contractual and nationally required quality performance metrics, including HEDIS and customized state measures Audits: Oversee quality audits to ensure appropriate collection, tracking and reporting upon medical records required for focused quality improvement studies or regulatory audits Management of external contractors: Oversight of external contractors such as HEDIS contractor if needed Quality Liaison: Serve as a leader in cross-functional meetings to accomplish quality improvement and quality compliance goals, and serve as a liaison for regulators or other community-based organizations as needed Committees and Presentations: Facilitates health plan quality committees by either participating as appropriate or making formal presentations
Required Qualifications:Undergraduate degree Located in / near Phoenix Arizona Able to obtain minimum qualification as a CPHQ or CHCQM or already possess comparable education and experience in health plan data and outcomes measurement suitable to meet regulatory requirements 4+ years working in managed care quality department in Medicaid/Medicare or equivalent experience in non-managed care setting 2+ years demonstrated leadership and team development skills Proficiency in software applications that include, but are not limited to, Microsoft Word, Microsoft Excel, Microsoft PowerPointPreferred Qualifications:3+ years in Manager / supervisory position Proven success managing and implementing quality improvement programs Demonstrated ability to assist with focusing activities toward a strategic direction as well as develop tactical plans and drive performance Demonstrated problem solving skills with the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action Experience analyzing and presenting complex information to key stakeholders verbally and in written formCareers 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) 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. Job Keywords: Quality Manager, Manager Clinical Quality, CPHQ, CHCQM, managed care, Medicare, Medicaid, regulatory, HEDIS, manager, supervisor, Phoenix, AZ, Arizona
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.