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Job Details

UnitedHealth Group

Senior Quality Program Manager - Remote


Nurse Manager


Raleigh, North Carolina, United States

UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm)

The Senior Clinical Quality Program Manager will work closely with the Health Plan Quality Leadership to coordinate an interdisciplinary approach to improve member outcomes and provider performance. Primarily responsible for the development and/or on-going management and administration of clinical quality programs. Provides implementation support, measurement standards, and revisions as needed that incorporate applicable best practices with proven outcomes. This position will focus on tasks that occur in accordance with State of NC, CMS, NCQA or other requirements as applicable. The Position reports to the Manager of Clinical Quality.

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

Primary Responsibilities:

  • Designs clinical quality transformation through targeted creation of overall program/process framework based on applicable research and evidence-based guidelines
    • Define specific program/process requirements and expectations
    • Evaluate workflows, efficiencies, and best practices to determine program/process specifications
    • Identify skill, knowledge, and certification requirements for program/process implementation based on requirements
    • Develop program/process tools and resources based on workflow requirements
    • Identify technology needs to support programs/processes and provide or coordinate system and reporting requirements
    • Obtain input and feedback from stakeholders during program/process development
    • Communicate program/process goals and status of program/process development with stakeholders
    • Deliver formal presentation of proposal/recommendation of findings to build support for programs and processes
  • Collect and evaluate data and information to identify clinical best practices
    • Collect and submit data to relevant agencies for accreditation or compliance review
    • Gather data and respond to customer, regulatory, or internal evaluation requests
    • Collect information, input, data, and subject matter expertise relevant to identifying best practices
    • Conduct analysis of data, metrics, information and reports (e.g., productivity metrics, outcomes)
    • Identify internal and/or external trends and business opportunities (e.g., market competition, new technology applications) and identify opportunities for program development
    • Use a process driven approach to identify root cause and process improvement opportunities (e.g., DMAIC method, Six Sigma, PDSA, Pareto charts)
    • Develop an understanding of internal and external customer needs
    • Review and interpret laws and regulations and determine their applicability within a given situation
  • Evaluate clinical programs or processes to identify improvements
    • Monitor compliance against relevant process requirements
    • Evaluate processes and outcomes against benchmarks and metrics and identify potential business impacts of current state
    • Identify opportunities to increase efficiencies or effectiveness and recommended program implementation or process changes
    • Use a process driven approach to identify root cause and process improvement opportunities
    • Communicate and collaborate with key stakeholders regarding findings and recommendations
    • Prepare reports or document evaluation results
  • Implement clinical quality programs or processes
    • Oversee or assist with program or process implementation
    • Coordinate with others to develop program or process implementation plans
    • Secure buy-in from key stakeholders to program or process implementation plans
    • Provide operational or subject matter expertise to train others on program or process components (e.g., strategy, implementation)
    • Communicate program/process status with stakeholders
    • Mentor team members to guide and develop understanding of their functions/roles
    • Leverage technology to develop and deliver presentations and/or training

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:

  • Bachelor’s degree in clinically related field or public health
  • 4+ years of clinical experience in healthcare and/or insurance industry
  • 4+ years of quality improvement experience with responsibilities in the following areas: Model for Improvement and Plan-Do-Study-Act (PDSA) rapid cycle change, data analysis and interpretation, systems analysis, graphical display of data/information, public speaking, group leadership and facilitation, and demonstrated problem solving and critical thinking skills
  • Proficient in software applications skills that include, Microsoft Word, Excel, PowerPoint
  • Must be proficient with creating presentations and working with data
  • Travel required to State Sponsored Meetings & Greensboro, NC, office (10%)

Preferred Qualifications:

  • Graduate degree
  • Experience working in Medicaid and/or Medicare
  • CPHQ
  • Multilingual candidates
  • Knowledge of one or more of: clinical standards of care, preventive health standards, HEDIS, NCQA, governing and regulatory agency requirements, and the managed care industry
  • Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation

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 at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.(sm)

*All Telecommuters 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.