Manager Clinical Quality

UnitedHealth Group • Phoenix, AZ

310d • $89,800 - $176,700 • Onsite

About The Position

The Quality Manager provides strategic leadership and supports quality improvement and value-based programs in Arizona. This position oversees the Quality Team and drives innovation and strategy that leads to quality gap closure and increased HEDIS/ Star ratings. The Quality Manager will report to the market Director and is responsible for achieving quality performance of 4+ HEDIS/Stars in the region and works collaboratively with regional and market leaders in a matrix relationship.

Requirements

• 3+ years of progressive leadership experience preferably in healthcare
• Medicare and/or Managed Care experience
• Experience and proficiency using Microsoft Office applications, including Outlook, Word, PowerPoint, and Excel spreadsheets
• Solid knowledge of NCQA/HEDIS, CMS Stars and Clinical Quality Improvement
• Proven 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 and critical thinking skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action
• Demonstrated ability to interact with all organizational levels
• Proven ability to review clinical data and provide recommendations for improvement
• Up to 50% local travel may be required

Nice To Haves

• Registered Nurse or other related clinical experience or education
• Certified Professional healthcare Quality (CPHQ)
• Billing and CPT coding experience

Responsibilities

• Provide strategic leadership and develop innovative programs that improve quality HEDIS/Stars performance in the market
• Partner with the Director of Quality, Medical Director, and market leadership to ensure established quality goals are met
• Participate and present AZ market STAR performance in weekly, Monthly, Bi-monthly, Quarterly and/or Annual Business Review meetings
• Oversee and mentor the Quality Team in their day-to-day responsibilities including data abstraction, provider and clinical staff education, and practice specific business planning that motivates providers to improve quality performance
• Assist in developing STARS/HEDIS training and presentation materials and is the subject matter expert for all STARS-related activities within the market
• Aligns and coordinates activities and deliverables related to the CMS Star program, HEDIS data collection, Data Analytics and Reporting, Member/Provider Engagement, and CAHPS/HOS Member Surveys
• Perform all other related duties as assigned

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Industry: Insurance Carriers and Related Activities