[Hiring] Clinical Quality Manager @UnitedHealth Group

Role Description

The Quality Management Manager will monitor and support the health plan quality improvement initiatives with particular emphasis on HEDIS, NCQA, and State Performance measures. You'll act as a voice for our members, guiding the development of comprehensive care plans that will help others live healthier lives.

If you are located in Pennsylvania, you will have the flexibility to work remotely* as you take on some tough challenges. This position will travel up to 10% in the PA market.

• Oversee the implementation of plan’s quality improvement program (QAPI)
• Work to coordinate the work with the clinical, operations, and network teams to improve HEDIS and NCQA performance and to close gaps in care
• Manage Quality work plan programs and activities
• Collaborate across local and national business segments to achieve goals and targets
• Develop and maintain positive relationships with external state organizations within the scope of Quality Management
• Continuously monitor HEDIS, NCQA, and state performance measure results and adjust programs to ensure targeted goals
• Support Performance Improvement Projects, accreditation, and regulatory audits as needed
• Develop and mentor quality department staff
• Oversee quality quarterly review meetings with state partners
• Serve as panelist for grievance and appeal hearings

Qualifications

• RN License in the state of Pennsylvania
• AND/OR Master’s degree in a Healthcare Field (e.g. Public Health, Health Administration, Health Education, etc.)
• Experience with HEDIS and NCQA - quality improvement project experience
• Experience managing staff or staff management for projects
• Experience writing reports and managed care industry
• Experience with outside audit organizations such as External Quality Review Organizations (EQROs)
• Reside in the state of Pennsylvania and ability to travel up to 10% in the PA market

Requirements

• 2+ years demonstrated Management experience with responsibility for team performance management
• Quality improvement experience within a health plan
• Experience with Excel (working with pivot tables) and creating PPT presentations
• Medicaid experience
• Clinical experience/background
• Ability to make independent decisions
• Change management experience and demonstrated skills
• Ability to complete various deliverables utilizing scholarly writing and AI technology
• Experience with outside audit organizations such as External Quality Review Organizations (EQROs)
• Experience with managed care and insurance industry
• Experience in writing reports and analyzing performance data
• Experience creating detailed reports and project management

Benefits

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