UnitedHealth Group is among the most ambitious Fortune 25 companies you'll ever meet. Through our family of businesses, we're working to make the health care system perform better for more people, in more ways than ever.
Simply put, we think the entire system can be greater than it's ever been. And that drives us to work harder, aim higher, and expect more from one another.
Here, you'll be empowered to make an immediate impact for millions of others. And you'll achieve more than you ever expected. How does that fit with your plans?
Health Plan - Associate Director Clinical Quality - Wauwatosa, WI-310625
UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health.
Description AmeriChoice is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.
If you're ready to help make health care work better for more people, you can make a historic impact on the future of health care at AmeriChoice.
We contract with states and other government agencies to provide care for over two million individuals. Working with physicians and other care providers, we ensure that our members obtain the care they need with a coordinated approach.
This enables us to break down barriers, which makes health care easier for our customers to manage. That takes a lot of time. It takes a lot of good ideas. Most of all - it takes an entire team of talent. Individuals with the tenacity and the dedication to make things work better for millions of people all over our country.
Position Description:
Positions in this function include those responsible for a variety of functions in areas such clinical quality program implementation throughout the Assigned Health Plan that includes but is not limited to improvement, monitoring and assessment; HEDIS improvements; NCQA accreditation; quality regulatory compliance; and oversight of quality of care/service issues resolution.
Primary Responsibilities:
- Provides leadership to and is accountable for the performance of plan based managers and/or senior level professional staff
- Manages all Quality improvement functions for assigned health plan
- Directs Quality initiatives to improve member care and meet state regulatory requirements for Quality Improvement projects (including state-mandated Performance Improvement Projects)
- Ensures barrier analysis to identify opportunities to improve member care and quality metrics at local health plan level with support from National Quality Management staff
- Participates in development, management and monitoring of national quality improvement projects
- Oversight of HEDIS RN's [where applicable] and other Plan Quality staff
- Provides direction and guidance on clinical quality improvement and management programs including accreditation, regulatory requirements and the HEDIS Nurse program [where applicable]
- Conducts clinical quality audits and may also be responsible for NCQA requirements
- Responsible for the reporting and analysis of member care quality, provider and member satisfaction, access and availability, coordination of provider credentialing with national process, and for the development of plans and programs to support continuous quality improvement using HEDIS and other tools
- Supports national quality activities such as the physician profiling/P4P program and the Appeal & Grievance Unit QOC/S resolution as needed
- Responsible for implementation and approval of the QI Program and Workplan as well as the development and approval of the annual QI Program Evaluation in accordance with AmeriChoice model
- Facilitates health plan quality committees in accordance with AmeriChoice model, such as the Quality Management Committee and the Provider Affairs Subcommittee and participates as appropriate on national quality meetings
- Oversees Provider Profiling and Pay 4 Performance Programs in accordance with AmeriChoice model
You can be a part of this team. You can put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered. Qualifications
Qualifications:
- Clinical Registered Nurse with current licensure preferred
- Bachelors degree in Science or Business or equivalent experience required. Masters degree preferred
- 8+ years clinical practice experience or equivalent experience
- 4+ years working in managed care quality department experience required or equivalent experience.
- Proven success managing, implementing and auditing clinical quality programs
- 4+ years demonstrated leadership and team development skills or equivalent experience
- Certified Professional in Healthcare Quality (CPHQ) certification preferred
- Proficiency in software applications that include, but are not limited to, Microsoft Word, Microsoft Excel, Microsoft PowerPoint
- Demonstrated ability to assist with focusing activities toward a strategic direction as well as develop tactical plans, drive performance and achieve targets
- Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action
- Excellent 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
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. |
