Clinical Quality Manager - Remote in Pennsylvania

UnitedHealth Group•Philadelphia, PA

3d•$91,700 - $163,700•Remote

About The Position

The Quality Management Manager will monitor and support the health plan quality improvement initiatives with particular emphasis on HEDIS, NCQA, and State Performance measures. You'll act as a voice for our members, guiding the development of comprehensive care plans that will help others live healthier lives. If you are located in Pennsylvania, you will have the flexibility to work remotely as you take on some tough challenges. This position will travel up to 10%25 in the PA market.

Requirements

RN License in the state of Pennsylvania AND/OR Master’s degree in a Healthcare Field (e.g. Public Health, Health Administration, Health Education, etc.)
Experience with HEDIS and NCQA - quality improvement project experience
Experience managing staff or staff mgmt. for projects
Experience writing reports and managed care industry
Experience with outside audit organizations such as External Quality Review Organizations (EQROs)
Reside in the state of Pennsylvania and ability to travel up to 10%25 in the PA market

Nice To Haves

2+ years demonstrated Management experience with responsibility for team performance management
Quality improvement experience within a health plan
Experience with excel (working with pivot tables) and creating PPT presentations
Medicaid experience
Clinical experience/background
Ability to make independent decisions
Change management experience and demonstrated skills
Ability to complete various deliverables utilizing scholarly writing and AI technology
Experience with outside audit organizations such as External Quality Review Organizations (EQROs)
Experience with managed care and insurance industry
Experience in writing reports and analyzing performance data
Experience creating detailed reports and project management

Responsibilities

Oversee the implementation of plan’s quality improvement program (QAPI)
Work to coordinate the work with the clinical, operations, and network teams to improve HEDIS and NCQA performance and to close gaps in care
Manage Quality work plan programs and activities
Collaborate across local and national business segments to achieve goals and targets
Develop and maintain positive relationships with external state organizations within the scope of Quality Management
Continuously monitor HEDIS, NCQA, and state performance measure results and adjust programs to ensure targeted goals
Support Performance Improvement Projects, accreditation, and regulatory audits as needed
Develop and mentor quality department staff
Oversee quality quarterly review meetings with state partners
Serve as panelist for grievance and appeal hearings