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Job Details

Quality Management Manager - Indianapolis, IN




Indianapolis, Indiana, United States

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 and start doing your life's best work.(sm)

The quality management manager serves as OMPP’s contact for quality performance measures and directs the activity of quality performance staff in monitoring and auditing our health care delivery system, including, but not limited to, internal processes and procedures, provider network(s), service quality and clinical quality as it relates to Managed Long-Term Services and Support (MLTSS) program. This position will be based in Indiana.

Primary Responsibilities:

  • Assists the compliance officer overseeing the activities to meet the State’s goal of providing health care services that improve the health status and outcomes of MLTSS program members
  • Serves as MLTSS key staff Quality Management Manager and participates in State quality meetings and collaborative initiatives
  • Focuses organizational efforts on improving clinical quality performance measures
  • Assists in the creation, implementation and evaluation of Quality Management and Improvement Program (QMIP) and Quality Improvement Work Plan to facilitate quality performance improvement
  • Identifies population-based member barriers to care and works with the Quality Management Committee (QMC) team to identify local-level strategies to overcome barriers and close clinical gaps in care
  • Uses data to develop intervention strategies to improve outcomes, including targeted strategies, to improve health disparaties
  • Supports quality improvement program studies with work that ranges from accessing and analyzing provider records, maintaining databases and researching to identify members’ encounter history
  • Designs practice-level quality transformation through targeted clinical education and approved materials related to HEDIS® and Indiana-specific quality measures for provider and staff education during field visits
  • Engages providers in strategies to improve outcomes through collaborative partnerships
  • Develops and implements performance improvement projects, both internal and across our health plans
  • Reports quality improvement and performance outcomes to OMPP

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 of Science degree in nursing or equivalent work experience
  • Current and unrestricted RN licensure in the state of Indiana or at a minimum a Certified Professional in Health Care Quality or Certified in Health Care Quality and Management or have comparable experience and education in data and outcomes measurement as described in 42 CFR §438.200 - §438.242
  • 5+ years of clinical or field-related experience
  • 2+ years of experience in quality improvement or related field such as Six Sigma
  • Knowledge of clinical standards of care, preventive health

Preferred Qualifications:

  • 2+ years of experience in MLTSS or similar product
  • Experience working in Medicaid or Medicare
  • Health care and insurance industry experience, including regulatory and compliance
  • Master’s degree

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)

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.