Quality Program Manager -Irvine, CA

UnitedHealth Group•Irvine, CA

1d•Hybrid

About The Position

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together. The Quality Program Manager is responsible for managing planning, implementation and reporting for quality focused programs that improve the health, well-being, and quality of care and service received by our members, as demonstrated by high quality measure performance in HEDIS Medicaid and CMS quality measures. This role will provide programmatic support for the quality program, including coordinating direct patient/ clinician outreaches, education, care reminders, specialist/ behavioral health referral support and quality performance reviews, to advance patient education and increase patient compliance. The role will partner directly with Quality Clinical Nurse Practitioner, Pharmacists, dedicated Medical Assistant, and also collaborate with internal and external key stakeholders, regional operations, IPA practices, FQHCs, and other community partners, to drive clinical relationships and engagements between members and the care delivery system. The focus of this role is Medicaid and Duals quality metric performance, which may include but is not limited to HEDIS, CMS Stars, Part D measure gap closure, and CAHPS/HOS patient experience performance. Hours for this role are Monday through Friday 8AM -5PM within PST. Please note this is a Hybrid Based role and you will be required to work 3 days a week in the office, located at 9 Technology Dr. Irvine CA 92618. The ideal candidate will be: Self-directed, able to manage multiple priorities, and coordinate complex cross-functional project plans, to drive execution of strategies. Accountable for demonstrating improvement in quality, patient experience and optimized patient outcomes. Skilled at utilizing data to drive decisions and has a passion for applying technology to achieve systematic solutions. Passionate about continuous improvement, streamlined processes and workflow optimization. Energized by new challenges, thrives in a fast-paced, dynamic environment, collaborates well in a collaborative atmosphere.

Requirements

2+ years of project management experience
Experience working with programs in HEDIS, Quality, Stars, CAHPS/HOS
Experience in managed healthcare or care delivery operations
Demonstrated ability to work independently, without direct supervision
Excel – Demonstrated ability to create, manipulate and formulate Excel spreadsheets using v-lookup, pivot tables, charts and graphing
Proven flexible, multi-prioritizing skills and time management skills
Proven intermediate MS Office skills
Proven PowerPoint Presentation skills
Proven excellent communication skills
Driver’s License and access to a reliable transportation

Nice To Haves

Provider office administrative or retail pharmacy experience
Project management certification
Experience with Technology-based Solutions (EHRs, IVR, Texting Applications, etc.)
CLL (Common Language of Leadership) Values Based Competencies
Achievement Drive
Sets ambitious stretch goals
Shows initiative
Attacks tasks with energy and confidence
Motivates others with infectious enthusiasm
Deploys self against goals and objectives
Critical Thinking
Collects essential and relevant information
Assesses value and connectedness
Synthesizes information
Applies multiple analytical tools
Generates conclusions and probable best solutions
Runs scenarios
Engagement Management
Understands what motivates people to excel
Builds a culture of engagement everywhere
Tracks engagement and adjusts to feedback
Reacts to early warning signs of disengagement
Runs a collaborative team
Leveraging Innovation
Anticipates opportunities
Generates and collects ideas
Synthesizes and combines ideas
Translates ideas into products/services
Creates an innovative friendly culture
Supports all innovation
Personal Impact Management
Assesses their personal impact against requirements
Develops a style aligned to culture
Manages their leadership shadow
Gets feedback on personal impact and effectiveness
Task & Project Management
Defines goals and outcomes
Aligns and deploys people, resources, tasks, and timelines
Uses on-going measurement and adjustment process
Provides on-time feedback and guidance

Responsibilities

Under direction of the VP, Government Programs and in collaboration with other stakeholders, the Quality Program Manager will project-manage implementation of strategic quality focused programs that improve the overall health and service provided to our Medi-Cal patients. The goals of the program may include:
Managing workflows for patient educational and reminder outreach calls to targeted patients (e.g., high risk patients with a recent ED discharge, patients with multiple chronic conditions, such as diabetes and hypertension)
Tracking patient outreach registries
Tracking patients who received counselling and educating regarding clinical and behavioral health benefits, health plan network and other programs and tools available to help improve quality of lifestyle
Tracking patients with an established plan and/or various patient opportunity cohorts
Helping coordinate and track follow up care received after scheduled labs, screenings, post ED visits, specialist and/or behavioral health referrals, and repeat ED utilization
Supporting engagements to targeted clinicians with high volumes of high-risk patients with multiple chronic conditions, ED visits and those needing education on quality measures
Ensuring clinicians receive education on measure requirements
Support in reviewing strategies to reinforce Rx therapy and Medication Adherence
Managing clinician behavioral health and substance abuse assistance programs
Liaising with provider offices on labs, refill orders and prior authorizations
Support with scheduling outreach to providers in suspected medication abuse situations
Responsible for tracking, trending and reporting effectiveness of quality programs for executive leadership and health plan grant reporting (e.g., targeted measure results, program reach and participation, demographic data, providers engaged, etc.)
Optimize partnerships/ synergies with other accountable business units (e.g., Population Health, Provider Relations, Clinical Services, Marketing, Legal/Compliance, etc.)
Help organize and participate in cross-team program collaborations through detailed, time/role-specific project plans, to ensure clear consistent direction, communication, documentation, and division of responsibility.
Develop and implement strategies to improve quality and patient outcomes
Consistently support compliance by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting noncompliance, and adhering to applicable federal, state, and local laws and regulations, accreditation, and licenser requirements (if applicable), and current corporate and client policies and procedures
Partner with leaders and other functional business areas and other duties and initiatives as assigned