Manager Clinical Quality – Phoenix, AZ

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. 

This position requires an experienced mid-market professional familiar with the general operations of a Medicaid MCO and knowledgeable of quality improvement functions within a Medicaid market. This position will be responsible for management of professional staff. The success of the quality improvement program depends on teams outside of the department that support critical activities, and the ability to professionally communicate, influence, and build relationships with departments and staff outside span of control within a shared services environment is critical to success in this role.

This position leads the health plan’s Quality improvement Clinical Practice Consultant (CPC) program. The primary purpose of the CPC program is to engage with ACOs and PCPs to drive improvement on priority performance measure goals, reporting and analysis of quality performance measures, oversight of audits related to regulatory requirements, development of plans and initiatives to support continuous quality improvement using HEDIS® measures and other tools, and contributing to regulatory deliverables.

If you are located in the Phoenix, AZ metro area, you will have the flexibility to work remotely* as you take on some tough challenges. Occasional travel throughout the state may be required.

Primary Responsibilities:

• Team Management: Provides leadership to and is accountable for staff within the quality management department, including Clinical Practice Consultants (CPCs) who conduct provider-focused interventions to meet Medicaid quality performance goals
• Performance Improvement: Responsible for exceeding priority PRI performance measure goals and maintaining or improving performance on other contractual and nationally required HEDIS® and state performance measures. Serve as performance measure SME for internal and external stakeholders
• Provider Incentive Programs: Identify and coordinate provider participation in provider incentive programs
• Provider education: Develop provider education on performance measures and regulatory requirements, including but not limited to HEDIS, EPSDT and VFC program requirements
• Supplemental Data: Serve as health plan’s supplemental data SME for internal and external stakeholders
• ACO Engagement: Active participation in JOC and quality meetings with ACOs and health plan stakeholders
• Talking Points Agenda: Create monthly provider “Talking Points” agendas for CPCs
• Provider Compliance: Monitor and ensure provider compliance on EPSDT and other regulatory requirements
• Corrective Action Plans: Develop and/or assist with corrective action plans, as indicated
• HEDIS® and/or CMS Core Hybrid Audits: Coordinate with national medical record collection and chart review teams to ensure successful hybrid audits
• Policies & Procedures: Create and maintain policies and procedures for health plan CPC program
• Quality Audits: Oversee quality audits to ensure appropriate collection, tracking and reporting for focused quality improvement studies or regulatory audits. Develop understanding of regulatory requirements and/or expectations to determine appropriate course of action
• Quality Liaison: Serve as a leader in cross-functional meetings to accomplish performance improvement and quality compliance goals and serve as a liaison for regulators or other community-based organizations, as needed
• Committees and Presentations: Participates and presents in quality committees

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• Undergraduate degree
• Active Unrestricted Registered Nurse License in AZ.
• 5+ years working in managed care quality performance improvement role with Medicaid/Medicare or equivalent experience in a non-managed care setting
• 5+ years of experience analyzing performance improvement data and identifying opportunities for improvement
• 3+ years in Manager / supervisory position
• 3+ years of experience working directly with HEDIS® and CMS Core Set performance measures
• Experience analyzing and presenting complex information to key stakeholders verbally and in written form
• Proficiency in software applications that include, but are not limited to, Microsoft Word, Microsoft Excel, Microsoft PowerPoint
• Proven ability to obtain minimum qualification as a CPHQ or possess comparable education and experience in health plan data and outcomes measurement
• Demonstrated ability to assist with focusing activities toward a strategic direction as well as develop tactical plans and drive performance
• Located in Phoenix, Arizona metro area

Preferred Qualifications:

• Experience working in a primary care setting
• Experience working with ACOs
• Demonstrated problem solving skills with the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

The salary range for this role is $89,800 to $176,700 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes – an enterprise priority reflected in our mission.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.