- Devise, communicate, monitor and intimately understand the H contract path to 4 (plus) stars and coordinate with both the Quality Field Organization and M&R leadership on all activities that ensure 4 star performances
- Be considered the center of the data strategy; meaning constantly be mining data to find all opportunities for performance improvement in all aspects of Stars performance including HEDIS Part C and D, operations (e.g., disenrollment, appeals etc.), CAHPS/HOS market level detail from various sources such as KMI, Eliza CAHPS/HOS surveys, offseason CAHPS/HOS surveys etc.
- Create a year round HEDIS chase strategy with particular focus on spring collection and abstraction best practices; driving best in class rate max activities in coordination with HEDIS Ops and QFO
- Actively coordinate with all Medicare & Retirement national functions (Product, Sales, Marketing, Member Experience, Finance), UnitedHealthcare shared services functions (Network, Clinical, Quality, Operations), Optum (Local Care Delivery, HouseCalls, Complex Population Management), lines of business (M&R, DSNP, ISNP, Group) and local leadership (Local EDs, CEOs) to leverage local market knowledge and establish and drive local tactical plans for improving CMS Star ratings and quality for assigned H-Contracts
- Coordinate with Network and Optum teams to provide H-Plan Leads, Practice Performance Managers and embedded Practice Resources strategic direction; approve performance targets / metrics; ensure performance to targets. Includes positive physician HEDIS run-rate performance; development and use of appropriate supporting tools (HouseCalls, CAHPS/HOS tools, documentation training)
- Partner with local health plan team, Network, Market Medical Director and Optum to increase HouseCalls completion rates and reduce refusal rates
- Meet all assigned performance targets
- Maintain strong relationships with Medicare & Retirement national functions, UnitedHealthcare shared services functions and Optum businesses through regular communications and face to face contacts.
- Exemplify and model Our United Culture and live our values with conviction
10+ years of experience in a large, complex and successful health care / managed care organization with demonstrated track record of increasing responsibility and accountability
In-depth experience with health care providers / networks
Demonstrated strong financial / analytical skills
5+ years experience with Medicare experience (to include CMS Star ratings, HEDIS measures and clinical quality)
Demonstrated success building relationships with external executives and stakeholders
- Bachelor’s degree
- Experience in a Medicare Advantage business
- Strong written and verbal communication skills, including well-developed interpersonal skills used to influence the behavior of others across a highly-matrixed organization
- Track record of meeting business goals via driving disciplined, fact-based decisions and executing with discipline and urgency
At UnitedHealthcare, we're addressing the social drivers of health ? and helping to change the broader circumstances of members' lives ? providing greater stability, access, and wellbeing that can allow members to rise out of poverty. What's more important than that? So join us and lead initiatives to influence state or national policy and do your life's best work.SM
Careers at UnitedHealthcare Medicare & Retirement.
The Boomer generation is the fastest growing market segment in health care. And we are the largest business in the nation dedicated to serving their unique health and well-being needs. Up for the challenge of a lifetime? Join a team of the best and the brightest to find bold new ways to proactively improve the health and quality of life of these 9 million customers. You'll find a wealth of dynamic opportunities to grow and develop as we work together to heal and strengthen our health care system. Ready? It's time 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.
Job Keywords: Associate Director of Quality Performance, Multi State H-Plans, Telecommute, telecommuter