Manager Quality Operations

Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life’s best work.(sm)

The Quality Manager is responsible for driving consistency in program implementation designed to facilitate a minimum of a 4 Star quality rating. These initiatives should result in contracted network being able to understand and support the vision to change the face of healthcare delivery for seniors. This will drive the financial viability of the market HEDIS/Star program and provide a full quality of care for the members. The responsibilities of this position demand a wide range of capabilities including: strategic planning and analysis skills; strong understanding of HEDIS and coding; management breadth to direct and motivate; highly developed communication skills; and the ability to develop clear action plans and drive process, given often ambiguous issues with numerous interdependencies. This position will facilitate any unresolved issues that remain as a result from following the standard process.

Primary Responsibilities:

• Manages Quality Coordinators, Clinical Quality Consultants (CQC) I, II and Senior CQC and/or support staff (Community Health Care Worker, Transition Care Navigators) is responsible for the overall success of the market’s HEDIS/Star results for contracted physicians
• All aspects of staff development to include hiring, training, coaching and development
• Maximizes staff performance and technical expertise through clearly defined objectives, training, skill development and leadership to ensure quality services to all customers
• Delegate, monitor and control work progress on key HEDIS/Star metrics, initiatives/action plans, staff productivity, and administrative expenses
• Participates in development and implementation of systems and processes that support quality operations
• Maintains effective cross functional services by working effectively with the Medical Director, Market Medical Director, Market Operations, Regional Team, Clinic Operations and other corporate departments
• Handles complex and/or difficult provider inquires and/or problems and facilitates resolution of provider issues. Continuously strive to ensure that favorable relationships are maintained while ensuring the interest of the organization
• Takes ownership of total work process and provides constructive information to ensure physician partners have support to meet initiatives
• Analyzes data while collaborating and/or participating in discussions with colleagues and business partners to identify potential root cause of issues
• Demonstrate understanding of providers' goals and strategies in order to facilitate the analysis and resolution of their issues
• Work with relevant internal stakeholders to identify obstacles and barriers identified by providers, and methods for removing them
• Communicate and advocate providers' needs to internal stakeholders in order to drive creation of solutions that meet our HEDIS/Star goals
• Communicate industry and company information to providers through various means (e.g., newsletters; emails; outreach calls; teleconference; conferences; on-site meetings)
• Develops and coaches staff to facilitate strategic business meetings with physician groups and their staff
• Guides, oversees and ensures competency of the Quality market staff
• Assist corporate and local education team and provides input on tools used to education quality staff and other local provider support staff
• Ensures all education objectives are being met, both on a formal and ad-hoc basis.
• Ensuring the quality staff is responding to market operation and provider inquiries
• Facilitates provider discussions and assists in negotiating resolution to escalated provider issues with the capability to determine if/when issues require escalation
• Collectively works with cross functional leadership to eliminate duplication of efforts and member or provider abrasion
• Performs all other related duties as assigned

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 Health Care Administration, Business Administration, Public Administration, Nursing, or a related field required. OR an Associate Degree with 4 additional years of comparable work experience beyond the required years of experience may be substituted in lieu of a bachelor’s degree)
• Master’s degree in Healthcare Administration, Business Administration, or a related field
• 4+ years of related experience in Quality/HEDIS/CMS Stars, and ICD10/CPT/CPT II coding knowledge, Provider Relations
• 1+ years supervisory or team lead experience
• Solid working knowledge of Medicare quality operations including HEDIS, Stars, Coding and Medicare Advantage
• Knowledge of state and federal laws relating to Medicare
• Advanced Microsoft Office skills. Must be proficient in Excel
• Ability and willingness to travel locally
• 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:

• Project Management experience
• Solid knowledge base of clinical standards of care, preventative health and STAR measures
• Solid financial analytical background within Medicare Advantage plans (Risk Adjustment/STARS Calculation models)

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 WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 550,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)

WellMed was founded in 1990 with a vision of being a physician-led company that could change the face of healthcare delivery for seniors. Through the WellMed Care Model, we specialize in helping our patients stay healthy by providing the care they need from doctors who care about them. We partner with multiple Medicare Advantage health plans in Texas and Florida and look forward to continuing growth.

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: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.

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