CHIP Program Manager - Remote in Pennsylvania
About The Position
At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together The CHIP Program Manager leads quality management, regulatory compliance, and operational oversight for the CHIP program, ensuring alignment with state and federal requirements, NCQA accreditation standards, and contractual obligations. This role serves as a key liaison to state partners and stakeholders, supports quality performance initiatives and reporting, and collaborates cross functionally across operational teams to advance program effectiveness, compliance, and member experience. If you are located in Pennsylvania, you will have the flexibility to work remotely as you take on some tough challenges.
Requirements
- Bachelor’s degree in a business or healthcare related field
- 2+ years demonstrated Management experience of a team or projects and responsibility for performance management
- 1+ years of Quality improvement or operations experience within a health plan
- Demonstrated experience with project management
- Experienced professional who has experience doing presentations, leading projects and engaging with external regulatory agency partners
- Experience working with senior leadership team.
- Reside within the state of Pennsylvania
Nice To Haves
- Preferred experience in vendor relations and setting up contracts
- Experience with writing reports on outcomes of projects and maintaining project plans
- Clinical knowledge
- HEDIS knowledge
- Proven ability to run data queries and manipulate clinical data or operational reports
- Proven ability to make independent decisions
- Demonstrated change management experience and skills
Responsibilities
- Oversees the implementation of plan quality management components, including quality management committee project management and governance structure
- Proactively manages and responds to rapidly changing state requirements and environments- has done presentations and interacted with state partners
- Collaborates across business segments to attain or maintain the plan’s compliance with NCQA accreditation standards and contractual requirements as they apply to the quality management program
- Develops and maintains positive relationships with the state External Quality Review Organization (EQRO) within the scope of the quality management program
- Submits reports and is experienced with excel, word, PPT and has some knowledge of manipulating quality data to meet state reporting. (SQL)- HEDIS background knowledge
- Understand operational components of a health plan such as enrollment, claims, member services, network and vendor relations
- Stakeholder and government relations: Serve one of the main liaison to Bureau of CHIP and represent the organization in State facing venues. Help to effectively communicate State expectations and directives to internal team members
- Regulatory and policy oversight: Monitor state and federal regulations, ensure compliance, and ensure implementation of policy changes impacting the CHIP Program (in partnership with COPA and Compliance leads). This includes ensuring submission of required reports accurately and on time
- Quality and performance: Work with internal quality management teams on performance improvement programs and serve as the contact for quality metrics like HEDIS and CAHPS for the CHIP membership
- Program and operational management: Oversee program administration, and support cross-functional collaboration (Lead by Compliance and COPA)) to ensure program goals and State expectations are met
- Member and partner communication: Serve as escalation point for member materials review and approval challenges including those requiring direct outreach and escalation to State contacts. Manage external communications with partners and legislative offices
Benefits
- In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).
- No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives.
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What This Job Offers
Job Type
Full-time
Career Level
Manager
