Clinical Quality Manager - Regulatory & Accreditation - Remote in NC

UnitedHealth Group•Greensboro, NC

1d•Remote

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 This position provides for management of the organizational quality management program as a core service to Community & State Plans in a highly complex and at-risk environment. The Quality Manager – Regulatory & Accreditation works within highly matrixed relationships to ensure full implementation of the annual quality management program, inclusive of an annual Quality Management and Improvement Program (QMIP) and a Quality Improvement Work Plan (QIWP) that considers opportunities identified in the prior year program Quality Improvement Evaluation (QIE). The program, and its various operational components, will comply with all state Medicaid and any associated federal regulatory requirements. This position develops and maintains strong relationships with state regulators as applicable. It further collaborates with staff of multiple departments that may include Clinical, Physician Engagement, Member Experience, Benefit Design/Product, Compliance, Network, Behavioral Services, and Pharmacy as needed to support quality management program initiatives. Lastly, the actively supports the development of content in support of RFP submission, as may be pursued. If you are located in NC, you will have the flexibility to work remotely as you take on some tough challenges.

Requirements

2+ years of leading an integrated and progressive quality program, preferably within health care industry
2+ years of demonstrated functional knowledge related to regulatory adherence of a quality management program, NCQA® accreditation, EQRO oversight audits, state Medicaid reporting, quality committee management
1+ years of supervisory, team leader, or management experience
1+ years excellent relationship building skills and performance/results driven
1+ years of experience presenting to executives using advanced written and verbal communication skills
1+ years of knowledge of the managed care/health insurance industry, products and services
Advanced computer skills, knowledge of MS Office products
Must be willing to travel within the state of North Carolina up to 25%25

Nice To Haves

Master’s degree in a health-related field
Knowledge of North Carolina Medicaid
Local candidates to the state of North Carolina
Proven solid influencing and negotiation skills with the ability to make independent decisions
Proven solid team building, collaboration and motivational skills
All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

Responsibilities

Partner with Director of Quality and other UHC Community Plan of North Carolina health plan leaders to ensure development and complete implementation of the annual Health Plan Quality Management Program, inclusive of adequate quality oversight processes and comprehensive quality committee structure
Foster and maintain productive and collaborative relationships with the state of North Carolina Department of Health Benefit (DHB) quality personnel
Act as a subject matter expert regarding NCQA® Health Plan and Health Equity accreditation and state regulatory requirements deemed in scope for Quality
Establish an annual reporting calendar which enables proactive organizational work on report production that facilitates ability for internal review no less than three weeks prior to internal due dates and actual submission in accordance with timelines established by the health plan
Oversee the process of producing assigned QAV/Quality reports to DHB's specifications
Take steps to ensure validity of data and/or narrative content prior to submission by engaging appropriate SMEs
Escalate when identified issues remain unresolved in a timeframe that enables correction prior to due date
Act as lead on creation and submission of The annual QMIP and QIWP The Annual Quality Assessment and Performance Improvement (QAPI)
Oversee the submission of the Performance Improvement Plans (PIPs)
Develop quality operational policies and procedures (P&Ps) as needed to ensure uniformity/consistency of operations
Monitor the effect of the quality committee structure and collaborate with health plan leaders to revise as needed to acknowledge organizational needs
Convey expectations regarding use of tools in establishing uniformity in approach when committee meetings are held, such as presentation of data, indication of action taken/to be taken, and evaluation of effect of action taken, as appropriate
Work with National contact to establish accreditation project plan, indicating actions needed at the Element and/or Factor level
Direct the engagement and education of various health plan functional areas in producing needed evidence to demonstrate compliance to NCQA®, EQRO, and DHB accreditation/audit/oversight requirements deemed in scope for Quality
Initiate and assess status of corrective action plans as needed
Supervise other Quality Department staff as indicated in organizational design