[Hiring] Network Quality Manager @UnitedHealth Group

Role Description

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
• Exception/fallout management activities

This role supervises and manages daily operations of auditors and analyst team. The Quality Manager is responsible for:

• End-to-end and all aspects of quality business process activities
• Quality planning, assurance, control, and improvement
• Supporting 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 including:

• Claims
• Appointment Scheduling
• Provider Data
• Customer Service
• Appeals & Grievances

The role partners cross-functionally with:

• Provider Data Operations
• Network Operations
• Network Adequacy
• Credentialing
• Compliance
• Quality teams

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

You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Qualifications

• 2+ years of Team Lead/SME experience with demonstrated abilities in Leadership and Emotional Intelligence
• 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
• 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 - 5:00 pm in Central Time Zone

Requirements

• 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

Benefits

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

Application Deadline

This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.