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)
The Director of Clinical Quality provides strategic leadership and direction for the quality improvement and management program(s) as a core service to Community & State Plans. The Director works within highly matrixed relationships to lead and develop the overall quality strategy for the plan, insuring the quality program is proactive, continuously improving, applies to all product and programs within the state, and includes both quality management/regulatory adherence and quality improvement.
This is an office-based position in either the Greensboro or Raleigh office location.
Oversees the development and implementation of plan quality program
Works to coordinate the work across HEDIS Operations, Data Analytics and Reporting, Accreditation, Member Surveys, Regulatory Adherence, Member Engagement, Medical Quality Applications, and other matrix partners, utilizing the expertise, standard process, and capabilities of these areas to enhance quality program performance of the plan
Partners to develop Quality Improvement plan playbook and quality targets
Oversees and directs as applicable quality improvement activities and interventions to close gaps in care and improve outcomes for identified critical quality measures
Ensures strong HEDIS performance
Collaborates across business segments to attain or maintain the Plan's compliance with accreditation standards and contractual requirements as they apply to quality
Develops and maintains positive relationships with State Agency stakeholders and State External Quality Review Organization within the scope of Quality Management and Improvement
Oversees and insures the creation, integration, maintenance, approval, and submission of the trilogy document, including but not limited to Quality Program Description, Work Plan, Evaluation, and Program Policies and Procedures
BS/BA in related field, or equivalent work experience
Unrestricted, current Clinical Licensure (e.g. LCSW, RN, MD, DO) in the state of NC, or the ability to obtain upon hire
5 years of experience in leading an integrated and progressive quality organization within a health care industry, preferably within managed care
5 years of significant leadership and managerial experience
5 years of demonstrated quality management/quality improvement experience in a large Healthcare Corporation serving Medicaid Beneficiaries
Quality Program Experience to include design mitigation, performance improvement, Medicaid specific quality initiative either in managed care or hospital based Medicaid patient focus
Intermediate computer skills- MS Office Suite- PowerPoint, Excel, Word
Expert knowledge of the managed care/health insurance industry, products and services
North Carolina State Medicaid program experience
Careers 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 Improvement, Quality Management/Regulatory Adherence, HEDIS Operations, Data Analytics and Reporting, Accreditation, Member Surveys, Regulatory Adherence, Member Engagement, Medical Quality Applications, Quality review, Performance Improvement projects, strategic leadership, quality strategy, strategic insight, quality outcomes, BS/BA, LCSW, Licensed Clinical Social Worker, RN, nurse, Registered Nurse, Medical Doctor, Doctor of Osteopathy, Doctor of Medicine, MD, DO, organizational behavior, Healthcare Corporation, Medicaid Beneficiaries, CPHQ, Medicaid, NC, North Carolina,
Unitedhealth Group Inc.