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Manager Of Quality Solutions Delivery - Telecommute

Expired Job

Unitedhealth Group Inc. Atlanta , GA 30301

Posted 2 months ago

UnitedHealthcare's Quality Solutions Delivery (QSD) (formerly HEDIS Operations) is an integrated team serving all UnitedHealthcare businesses, focused on improving the health of our members, enhancing our operational effectiveness, reinforcing brand and reputation for high-quality health plans and helping members lives healthier lives.

QSD combines talented individuals from many areas of quality, including HEDIS. Our goal is extraordinary performance that exceeds the expectations of the constituents, customers and members we serve.

In addition to supporting UnitedHealthcare as a whole, this position focuses on clinical quality improvement for our members.

In addition to working with the QSD staff, this position will collaborate and work closely with other key areas of quality including HEDIS National Operations, M&R Quality, STARS, CMS/SNP teams and others.

This position reports to the Regional Operations Director.

You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

  • Management of staff 6-8 QSD Specialists

  • Direct supervision

  • Accountability for improvement of all assigned HEDIS contracts

  • Advocacy for necessary process improvements uncovered during the chase

  • Reporting out results during HEDIS season, uncovering missing opportunities, working with field staff/providers/vendors/other LOB

  • Collaborate with Regional and Executive M&R Leadership

  • Process improvement projects

  • Reporting out on project status lots of market presentation responsibilities daily report analysis, rework, and directional shift

  • Contribute to and/or lead MAC and RQOC presentations

  • Identifying correct membership in the markets to be included in data collection.

  • Overseeing project build and QA

  • Creating opportunities based on data such as piloting 100% QA for a struggling measure

  • Collaborating with regional teams to map out data collection strategies.

  • Analysis of prior year results to guide future process

  • Identifying and leading process improvement initiatives

  • Identifying alternative sources for administrative data.

  • Current measure deep dives

  • Outside the box thinking to reach beyond departmental boundaries to garner resources

  • Participate in vendor training activities.

  • Ensuring collection and abstraction changes per tech specs are implemented

  • Identifying issues through the chase to bring forward for correction (CBP)

  • Calling out trends

  • Collaborate with Data and Analytics Team

  • A HEDIS SME

  • Identify and implement opportunities for rate improvement

  • Live Our United Culture everyday! Integrity, Compassion, Relationships, Innovation and Performance

Required Qualifications:

  • 5 years of Healthcare/Health Plan experience
  • 3 years of HEDIS experience and/or knowledge, including managing, planning and implementation
  • 1 year of managerial/supervisory experience
  • BS/BA Degree or equivalent experience (proven leadership in projects and/or personnel)
  • Strong proficiency with Microsoft Office applications, including: Word, Excel and PowerPoint

Preferred Qualifications:

  • RN or LPN

  • Experience working with HEDIS software vendors (management, relationship building, issue resolution)

  • Strong data management and/or project management skills

  • Demonstrated ability to assist with focusing activities toward a strategic direction and achieve targets

  • Solid knowledge of managed care requirements related to clinical quality

  • Centers for Medicare and Medicaid (CMS) Programs

  • National Committee for Quality Assurance (NCQA) Programs, including HEDIS and CAHPS

  • State specific Regulatory requirements

  • Experienced in medical record review

  • Basic statistical knowledge and application of continuous quality improvement concepts

Soft Skills:

  • Strong interpersonal skills

  • Ability to cultivate and work as a team

  • Excellent time management and prioritization skills

  • Excellent written and verbal communications 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)

  • All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

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: RN, Registered Nurse, LPN, Health Education, Clinical Review, Manager, Supervisor, Leadership, Quality, Quality Improvement, Process Improvement, Performance Improvement, Auditing, Health Care Analytics, Managed Care, Healthcare, HEDIS, Project Management, Six Sigma, Medicaid, Medicare, CMS, Atlanta, GA, Georgia, Boston, MA, Massachusetts, New York, NY, Fairfax, VA, Virginia, Ft Lauderdale, FL, Florida, Telecommute, Work from Home, UHG, UHC, UnitedHealthcare


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Manager Of Quality Solutions Delivery - Telecommute

Expired Job

Unitedhealth Group Inc.