Clinical Quality Manager - 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. 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. You’ll enjoy the flexibility to work remotely if you are located in Pennsylvania as you take on some tough challenges. This position is remote with up to 10%25 travel within the PA market.
Requirements
- RN License in the state of Pennsylvania
- 2+ years of experience with HEDIS and NCQA - this includes PIP and quality improvement project experience
- 1+ years of leadership/management experience (e.g., Review work of others, serve as an expert in their field, serve as a mentor and leader, lead functional or segment teams or projects, motivate and inspire team members)
- 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
- Reside in PA
Nice To Haves
- 2+ years demonstrated Management experience with responsibility for team performance management
- Quality improvement experience within a health plan- CPHQ Certification
- Experience with excel (working with pivot tables) and creating PPT presentations
- Medicaid experience
- Clinical experience / background
- Change management experience and demonstrated skills
- Proven ability to make independent decisions
- Proven ability to complete various deliverables utilizing scholarly writing and AI technology
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
Benefits
- comprehensive benefits package
- incentive and recognition programs
- equity stock purchase
- 401k contribution
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What This Job Offers
Job Type
Full-time
Career Level
Manager
Education Level
No Education Listed
