Director, Contract Stars Performance Improvement - Remote
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Come make an impact on the communities we serve as we help advance health equity on a global scale. Here, you will find talented peers, comprehensive benefits, a culture guided by diversity and inclusion, career growth opportunities and your life's best work.(sm)
This position has responsibilities for Quality Performance Improvement activities for specific contracts across multiple geographies. Serves on multiple Optum Clinical and Quality Committees and leadership teams designed to provide strategic direction for all local care delivery groups within Optum.
The Director, Contract Stars Performance Improvement provides strategic direction, leadership, and oversight for performance. This role is responsible for planning, organizing, and directing the administration of all Quality Programs\Strategies. Provides leadership to and is accountable for the performance and direction through multiple layers of management and senior level professional staff. Responsible for coordinating with appropriate personnel to meet operational program needs, ensures compliance with state/federal health plan requirements, Medicare guidelines, NCQA and health plan requirements. Provides long-term planning and oversight to ensure activities are appropriately integrated into strategic direction and operations, as well as the mission and values of the company.
You’ll enjoy the flexibility to work remotely* from anywhere within the U.S. as you take on some tough challenges.
- Provides leadership and support in establishing and directing the Stars Program for specific contracts
- Develops and maintains policies and procedures that support the corporate initiatives that meet State, Federal legal requirements, and standards
- Collaborates with physicians to execute the implementation of the Star initiatives as defined by enterprise and Optum Care
- Provides expertise to the training department on Star measures and tools that support collection of and communication about HEDIS/STAR to the enterprise
- Develops HEDIS/STAR member and provider engagement strategies
- Collaborates with enterprise-wide executive teams to execute HEDIS/STAR strategies
- Works with Optum Quality leadership team to provide HEDIS/STAR reporting and to develop strategic direction
- Facilitates, integrates, and/or coordinates the implementation and evaluation of identified CAHPS/HOS/quality improvement/HEDIS/STAR activities as requested by UHG/UHC or related companies
- Promotes understanding, communication, and coordination of all quality improvement program components
- Participates in requested evaluations and audits for UHC and other health plans
- Coordinates reporting on quality initiatives to all appropriate committees
- Participates in various teams, committees and meetings at any level required to maintain business necessity
- Maintains Star program documents, reports, and committee minutes and follows all internal privacy and confidentiality policies and procedures
- Oversees the CAHPS/HOS survey process for all contracted health plans
- Leads the coordination and completion of projects with cross-functional teams and senior leaders across quality functional areas to achieve targeted clinical strategic performance goals
- Oversees quality workflow mapping, performance monitoring, and coaching for using process improvement methodologies to identify workflow gaps and establish future-state recommendations
- Directs clinical quality best practice identification and standardization adoption with cross-functional teams and senior leaders
- Directs and promotes support with subject matter expertise and resources
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.
- 6+ years of management-level experience in managed care Quality programs
- Demonstrate knowledge of the business environment and business requirements (e.g., strategy changes, emerging business needs)
- Knowledge of CAHPS, HOS, NCQA HEDIS requirements and CMS STAR requirements
- Knowledge of fiscal management and human resource management techniques
- Ability and willingness to travel both locally and non-locally as determined by business need
- BA/BS degree in healthcare related field; clinical background (Registered Nurse or Nurse Practitioner)
- Ability to establish and maintain effective working relationships with employees, managers, healthcare professionals, physicians and other members of senior administration and the general public
- Excellent verbal, written communication, presentation, and facilitation skills
Physical & Mental Requirements:
- Ability to lift up to 25 pounds
- Ability to sit for extended periods of time
- Ability to use fine motor skills to operate office equipment and/or machinery
- Ability to receive and comprehend instructions verbally and/or in writing
- Ability to use logical reasoning for simple and complex problem solving
To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment
Careers with Optum. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges.
Colorado, Connecticut, Nevada, or New York City Residents Only: The salary range for Colorado residents is $113,500 to $218,100. The salary range for Connecticut/Nevada/New York City residents is $113,500 to $218,100. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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.
*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
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.