The HEDIS Line of Business (LOB) Director/VP is responsible for leading staff for an entire LOB (M&R, C&S or E&I) to develop, translate and execute the annual HEDIS strategy and process with excellence. Demonstrated HEDIS subject matter expertise is essential to job performance. The Leader is involved in all of the highly complex and critical elements supporting HEDIS operations. Primary Responsibilities: Data Preparation / Capture Administrative Data (Claims, Encounters & Supplemental Data) Hybrid Chart Chase / Collection Audits Abstraction /Rate Maximization Vendor Management Individual must be highly organized, possess strong leadership skills, with demonstrated professional maturity and emotional resilience Day to day work varies based on time of year, with overarching goal of developing strategies and organizing processes to increase collection of member compliant information resulting in improved HEDIS rates The position focuses on both pre-season data collection and year round data collection and utilization The core work during HEDIS collection season includes leading team in medical record collection and abstraction, Vendor Management, complete non-compliant review, and rate maximization Employs focused Line of Business (LOB) strategy, providing a priority measure approach to HEDIS data collection and GAP closure for each reporting population and is able to readily summarize LOB status of the project in relation to LOB goals Position is responsible for providing direction and guidance on clinical quality improvement and management programs including accreditation Leader is 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 This work is critical to the success of our organization as the results directly impact the profitability of our organization Set, plan and execute annual HEDIS strategy for a specific LOB as a HEDIS subject matter expert (including but not limited to process, audit requirements, submission timelines, NCQA requirements, National vs State level audit requirements) Identifying and implement strategies based on trends that impact collection, abstraction or compliance Works closely with senior leaders and across multiple levels of management of United's Healthcare's LOBs to align, translate and deploy strategies for successful HEDIS collection and reporting Work with your peers within HEDIS managing the other LOBs to collaborate where appropriate/possible Ensure adherence across all processes, to Compliance requirements for applicable LOB, including reporting and improvement of HEDIS and HEDIS-like state specific measures, collaboration with other HEDIS departments on identification and development of operational quality improvements Direct management oversight of business processes to improve compliance, external data collection & internal data collection, while optimizing quality and efficiency in support of organization objectives Builds and maintains alliances with customers, business partners, consultants, providers to meet/exceed business objectives. Key Processes - Hybrid Chart Chase, Abstraction, Administrative Data (Claims, Encounters & Supplemental Data), Data Preparation, Capture, Process Improvement, Pre-Season and Year-Round Data Plays leadership role in various aspects of key assignments & operational strategies Pursue continuous improvement in customer satisfaction, operational/performance metrics, processes, and competence of staff and cost reduction. Develops and implements regional/national operational plans in alignment with organizational population health strategies to achieve quality and affordability targets. Collaboration with DAR, Trainers, Regional Market staff, Vendor Consultants, Strategic Partners, Auditors and OptumInsight on all HEDIS deliverables Accountable for overall project activities Ensure State-specific deliverables and customer measures are met, where applicable Successfully recruits and develops staff to continuously improve their overall performance, effectiveness and engagement. Set, plan and assist the HEDIS managers in the contractor staff strategy for interviewing, hiring and onboarding Directs resources in most efficient manner to meet organizational objectives. Communicate project status along with risks, successes and mitigation plans Assets: Demonstrated ability to manage and develop people while prioritizing deliverables when faced with competing priorities Proven ability to influence course of action with diplomacy and tact when others are directly accountable for outcomes Passion for customers and a demonstrated focus on customer experience Energy, motivation, and commitment to drive to results in a challenging, fast-paced environment Demonstrated ability to meet commitments, build consensus, negotiate resolutions, and garner respect from other teams Diplomatic with strong negotiation and conflict resolution skills
Required Qualifications: Bachelors degree Master's preferred8-10 years' experience in leading significant and diverse operations in the healthcare services industry 7+ years of significant leadership and managerial experience 7+ years' experience, with demonstrated functional knowledge, process improvement initiatives, and organizational behavior Expert knowledge of the managed care/health insurance industry, products and services Working knowledge of NCQA's HEDIS Technical Specifications Working knowledge of NCQA's HEDIS processes and timelines including the NCQA HEDIS Technical Specification and audit requirements. Comprehensive understanding of functional areas and the impact in performance and performance measurement of quality Excellent written and oral communication skills with internal and external business partners and employees Strong influencing and negotiation skills Strong independent decision maker and risk taker Results-oriented Strong process and project management skills Strong team building and motivational skills Demonstrated leadership skills Demonstrated staff development skills Preferred Qualifications: Masters Degree4+ years' experience and knowledge of quality process audit readiness Certified Professional in Healthcare Quality (CPHQ) certification Superior planning and strong problem solving skills that enable quick identification and efficient resolution of issues Ability to influence others and build strong professional relationships Understanding of the financial principles and operations of the business and able to drive profitability & cost efficiency Business focus - understanding of company's vision mission and strategy to achieve long and short term goals Proven success in improved performance leading a large functionally aligned business segment/area. Ability to anticipate, understand and meet the needs of internal and external customers & constituents. Strong orientation to organizational cultural values: Integrity, compassion, relationships, performance & innovation Excellent oral and written communication skills. Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can 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.
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.