[Hiring] Associate Director of Stars and Quality @UnitedHealth Group

Role Description

Associate Director of Stars and Quality, Multi-State Contracts is accountable for both defining the strategy for getting UHC H-Contracts to 4+ Star performance on all membership within those plans and ensuring the strategy is carried out. These contracts cross states, markets and in some cases market CEOs; therefore the Associate Director of Stars and Quality must ensure all stakeholders are coordinating to drive high quality performance.

If you are located in Western/Central States, you will have the flexibility to work remotely* as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.

Primary Responsibilities:

• Devise, communicate, monitor and intimately understand the H-contract path to 4+ stars and coordinate with the Quality Field Organization, Accountable Care Organization Team, Optum Care, and M&R leadership on all activities that ensure 4+ star performances.
• Be considered the center of the data strategy; meaning constantly be mining data to find all opportunities for performance improvement in all aspects of Stars performance including HEDIS Part C and D, operations (e.g., disenrollment, appeals etc.), CAHPS/HOS market level detail from various sources such as KPI, CAHPS/HOS surveys, offseason CAHPS/HOS surveys etc.
• Collaborate with the MEGA contracts owner team, National STARs and HEDIS measure owners, and the West Region team to develop contract and market strategies, discuss best practices, and look for opportunities to partner with vendors to support measure closure.
• Create a year round HEDIS chase strategy with particular focus on spring collection and abstraction best practices; driving best in class rate max activities in coordination with HEDIS Ops, ACO, and QFO.
• Actively coordinate with all Medicare & Retirement national functions (Product, Sales, Marketing, Member Experience, Finance), UnitedHealthcare shared services functions (Network, Clinical, Quality, Operations), Optum (Local Care Delivery, HouseCalls, Complex Population Management), lines of business (M&R, DSNP, ISNP, Group) and local leadership (Local EDs, CEOs) to leverage local market knowledge and establish and drive local tactical plans for improving CMS Star ratings and quality for assigned H-Contracts.
• Coordinate with Network, ACO Team, QFO, and Optum Care teams to provide Practice Performance Managers, Clinical Transformation Managers, and embedded Practice Resources strategic direction; approve performance targets / metrics; ensure performance to targets. Includes positive physician HEDIS run-rate performance; development and use of appropriate supporting tools (HouseCalls, CAHPS/HOS tools, documentation training).
• Partner with Network, Market Medical Director, QFO, ACO, and Optum to increase HouseCalls completion rates and reduce refusal rates.
• Meet all assigned performance targets.
• Maintain strong relationships with Medicare & Retirement national functions, UnitedHealthcare shared services functions and Optum businesses through regular communications and face to face contacts.
• Exemplify and model Our United Culture and live our values with conviction.
• Other duties, as assigned.

Qualifications

• 5+ years of experience in a large, complex and successful health care / managed care organization with demonstrated track record of increasing responsibility and accountability.
• 3+ years of in-depth experience with health care providers / networks, CMS Star ratings, HEDIS measures and clinical quality.
• Willing and able to travel 30%+ depending on business need.

Requirements

• RN.
• Experience in a Medicare Advantage business.
• Solid written and verbal communication skills, including well-developed interpersonal skills used to influence the behavior of others across a highly-matrixed organization.
• Demonstrated success building relationships with external executives and stakeholders.
• Track record of meeting business goals via driving disciplined, fact-based decisions and executing with discipline and urgency.
• Demonstrated solid financial / analytical skills.

Benefits

• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase.
• 401k contribution (all benefits are subject to eligibility requirements).