Director of Quality HEDIS Operations, Texas South

UnitedHealth Group•San Antonio, TX

3d•$91,700 - $163,700•Hybrid

About The Position

The Director Quality Operations provides strategic leadership and direction for the quality improvement program to the local market. The Director of Quality Operations works within highly matrixed relationships to develop and operationalize the overall quality strategy for the market ensuring the quality program is proactive, continuously improving to include quality management / improvement and regulatory adherence. This position provides insight and direction to the market to align with a changing healthcare landscape as it applies to quality. He / she is responsible for driving and executing strategy to ensure optimal HEDIS / CMS Star results. Responsibilities including but not limited to HEDIS, CAHPS, HOS Standards, and Quality initiatives related to appropriate coding,, driving deployment and relentless day to day operational monitoring of region / market as applicable. The improvements will drive increased HEDIS / Star Ratings. This includes partnering closely with the VP of Quality, QRA Medical Director, and local market Cross functional leadership. The Director of Quality Operations is the population health expert for the market and assesses gaps in programs and disparities, proactively communicating the needs and driving innovation to find programs to work at the local or market level. The Director understands and influences Member and Provider Engagement Programs deployed in the market and assures day to day oversight to close member gaps in care.

Requirements

5+ years of significant and progressive leadership or managerial experience and responsibilities. Management of process or discreet work stream is acceptable
5+ years of experience in, and/or knowledge of, Clinical Quality and Quality Improvement processes required NCQA/HEDIS, CMS Star Program , ICD10/CPT/CPT II coding and CAHPS/HOS
3+ years of management experience
Excellent interpersonal skills
Superior verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others
Proven problem-solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action
Performance driven
Exceptional analytical and data representation expertise
Advanced knowledge of Microsoft Office applications, including, but not limited to, Word, Excel, Visio and PowerPoint
Driver’s license and access to reliable transportation

Nice To Haves

Clinical Registered Nurse or other related clinical experience or education
Certified Professional Healthcare Quality (CPHQ)
5+ years of experience working in managed care or a healthcare delivery system
Project Management experience
Solid knowledge base of clinical standards of care, preventative health and STAR measures
Solid financial analytical background within Medicare Advantage plans (Risk Adjustment/STARS Calculation models)

Responsibilities

Drives programs and initiatives to assure member access to care and gaps in care closure
Partners with VP of Quality, QRA Medical Director, and local market Cross functional leadership to ensure established quality goals are met
Manages assigned market / state Quality Improvement goals to drive and track data capture and collection, provider engagement and value based contracting, member engagement programs, clinical, and customer care touch points
Aligns and coordinates deliverables within their market / region and among the team including but not limited to: CMS Star program, HEDIS data collection, Data Analytics and Reporting, CAHPS Member Surveys, HOS member surveys, ICD10/CPT/CPT II coding capture related to Quality initiatives, and Regulatory Adherence, and Member/Provider Engagement
Display innovative problem solving and upholds principles of continuous quality improvement
Meet annual goals and objectives for the market and key metrics in conjunction & under the direction of the VP of Quality, cross functional teams and corporate goals and strategies to meet and exceed established program objectives
Monitors daily, weekly, monthly, quarterly, semi-annual and annual reports against goals to assess program success and alignment and to identify opportunities for improvement
Accountable for and assists with Quality Strategy Business Plan
Accountability for and knowledge of the Quality Improvement, CMS/Star Rating information and updates, NCQA/HEDIS, and gap metrics for assigned market
Appropriate application to form information to strategy to drive the market to excellence
Performs all other related duties as assigned