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Job Details

UnitedHealth Group

Director of Quality Management - Telecommute in North Carolina





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 Director of Quality Management for North Carolina, in collaboration with the Associate Director of Clinical Quality Outcomes, supports the implementation of health plan Medicaid quality program, with a strong focus on health equity. This is a key NC Department of Health and Human Services-facing role and leads efforts supporting NCQA accreditation, HEDIS reporting, EPSDT programs, and other regulatory compliance functions. This position is responsible for the design, writing, and submission of annual quality program evaluations and work plans to all regulators and will oversee quality audits related to regulator contractual requirements. The person in this role is expected to work directly with members of health plan leadership and to build relationships across the plan and enterprise. The individual must be comfortable with creating presentations and working with data to formally present information to providers, administrators, and state regulatory partners.

This role will supervise a team of clinical quality program managers within the UHC Community Plan of North Carolina. This role will collaborate with peers, including the Associate Director of Clinical Quality Outcomes and the Director of Health Equity, and will report to the Vice President of Clinical Strategy. This role requires North Carolina residence, is a telecommuting role, and can be based out of the employee's home. This role may require travel locally up to 10% of the time and up to 4 hours away from your residence on occasion. Travel will be required to State sponsored meetings and to the Greensboro or Raleigh office.

If you are located in Raleigh or Greensboro, North Carolina, you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

  • Partners with Associate Director of Clinical Quality Outcomes and other health plan leaders to ensure that the health plan quality oversight process is in place to successfully enable a high-performing, compliant quality program and optimal relationship with our NCDHHS quality program partners
  • Leadership and supervisory responsibility for the UHC Community Plan of North Carolina quality management program staff and the regulatory components of quality programs delivered by the plan
  • Partner with internal resources and external partners to ensure procedures and process are in place for a successful, compliant quality program, including for NCQA accreditation, HEDIS measure specifications and reporting, EPSDT programs, critical incidents, member incentives, and Access and Availability reporting
  • Directs as applicable process improvement plans and corrective action plans for surveys, accreditations, EQROs, and state audits, within the scope of quality management
  • Support larger regional and market team by sharing expertise and serving as a touch point/SME

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
  • Unrestricted RN license in the state of NC
  • 5+ years of healthcare industry quality improvement/performance improvement experience
  • 5+ years working with underserved populations
  • 3+ years of management/supervisory experience
  • 3+ years of experience working with accreditation with regulatory processes (NCQA, EQRO etc.)
  • Advanced knowledge base of clinical standards of care, preventive health, HEDIS measures, and regulatory processes
  • Proficient Microsoft Office skills with exceptional analytical and data representation expertise; Advanced Excel, Outlook, and PowerPoint skills
  • Excellent knowledge of the Medicaid market
  • 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

Preferred Qualifications:

  • Master’s degree
  • Managed care experience
  • NCQA Certified Content Expert Certification
  • CPHQ Certification
  • Project management experience
  • Six Sigma training
  • Ability to solve process problems crossing multiple functional areas and business units
  • Ability to analyze problems, draw relevant conclusions, and devise and implement an appropriate plan of action

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies now require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles require full COVID-19 vaccination 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 UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 5 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can 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.