Network Quality Manager - Remote

UnitedHealth Group•Eden Prairie, MN

2d•$72,800 - $130,000•Remote

About The Position

The Network Quality Manager is responsible for operational quality oversight, governance, monitoring, reporting, audit readiness, and quality improvement activities supporting provider data operations across medical and dental networks. This role ensures provider data integrity, provider directory accuracy, network adequacy support, credentialing quality support functions, and exception/fallout management activities are monitored and aligned with contractual, regulatory, and operational requirements. This role supervises and manages daily operations of auditors and analyst team. Quality manager is responsible for end-to-end and all aspects of quality business process activities to include quality planning, quality assurance, quality control and quality improvement. Quality manager supports risk reduction, auditing life-cycle activities, cost and productivity savings, reporting, and quality improvement initiatives. Monitors performance and completes system analysis in specific areas of quality to include: Claims, Appointment Scheduling, Provider Data, Customer Service, and Appeals & Grievances. The role partners cross-functionally with Provider Data Operations, Network Operations, Network Adequacy, Credentialing, Compliance, and Quality teams to support provider network reliability, operational performance, and enterprise quality objectives within the VA Community Care Network (CCN) program environment. Sets team direction, resolves problems and provides guidance to members of own team. Adapts departmental plans and priorities to address business and operational challenges. Influences or provides input to forecasting and planning activities. This role supports: Increase of quality metrics for operational business units Audit Calibrations with internal and external partners Audit Governance: Approves audit methodologies, sampling plans, and scoring standards Reporting & Stakeholder Communication Cost / productivity savings Risk reduction Error / defect reduction Process waste reduction Continuous improvement efforts

Requirements

2+ years of Team Lead/SME experience with demonstrated abilities in the following soft skills: Leadership and Emotional Intelligence success leading teams to deliver results and meet goals
1+ years of auditing experience
1+ years of experience analyzing and solving customer problems
Experience supporting quality, operational oversight, provider data, network operations, credentialing, compliance, or related operational functions with demonstrated understanding of basic quality programs
Experience working with operational metrics, reporting, quality monitoring, and process improvement activities
Experience working independently in less structured environments with moderately complex operational issues
Experience communicating operational risks, findings, and recommendations to leadership and stakeholders
Ability to work Monday - Friday, 8:00 am - 5:00pm in Central Time Zone

Nice To Haves

Lean, Six Sigma, Quality, HRO, or process improvement experience
Experience supporting healthcare operations, provider data operations, network management, or quality assurance programs
Experience supporting contractual quality requirements, audit readiness, or compliance monitoring activities
Experience with quality management systems, operational controls, or performance monitoring frameworks
Knowledge of provider directory operations, provider data management, network adequacy requirements, or credentialing operations

Responsibilities

Supervise and manage daily operations of auditors and analyst team
Lead operational quality oversight activities related to provider data integrity and provider network quality performance
Monitor provider data quality trends, fallout, automation exceptions, audit findings, and operational performance indicators
Support audit readiness activities, quality assurance reviews, and corrective/preventive action management
Ensure compliance with Quality Assurance Plan (QAP), QASP, contractual, regulatory, and operational quality requirements
Oversee quality monitoring and reporting activities related to provider directory accuracy, network adequacy support, and credentialing support functions
Identify operational risks, process gaps, and quality trends impacting provider network reliability and customer experience
Lead quality improvement initiatives focused on operational efficiency, risk reduction, data integrity, and process standardization
Partner with operational leaders and stakeholders to support quality governance, escalation management, and issue resolution activities
Support development and maintenance of operational controls, quality documentation, monitoring plans, and audit artifacts
Analyze operational data and performance metrics to identify trends, improvement opportunities, and potential compliance risks
Facilitate cross-functional collaboration to improve operational alignment and strengthen provider data quality processes
Support implementation of process improvements, monitoring controls, and operational governance activities across provider data operations standards
Addresses special (ad - hoc) projects as appropriate; Performs special project audits and reviews as requested by other departments/regions