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We have modest goals: Improve the lives of others. Change the landscape of health care forever. Leave the world a better place than we found it. Such aspirations tend to attract a certain type of person. Crazy talented. Compassionate. Driven. To these individuals, we offer the global reach, resources and can-do culture of a Fortune 5 company. We provide an environment where you’re empowered to be your best. We encourage you to take risks and in return, offer a world of rewards and benefits for performance. Exceeding your limits is an exceptional start to your life's best work.SM


Just like you, we are driven by a set of fundamental principles that are guiding our way forward. Our values of integrity, compassion, relationships, innovation, and performance serve as a foundation to transform health care. Are you in? Learn more about your future at UnitedHealth Group at careers.unitedhealthgroup.com


Job Category:

Business Operations



Approximate Salary:

Not Specified

Position Type:

Full Time

Associate Director of Quality Performance, California Health Plan - Telecommute

UHG - California, US

Posted: 12/13/2018

We have made a promise to the seniors we serve that we will support more effective care with networks focused on quality outcomes, a patient-centered clinical model and more members in high-quality rated plans – all delivered at the lowest medical costs and meeting and exceeding the expectations of CMS. The Associate Director of Quality Performance is accountable for both defining the strategy for maintaining the California Medicare Advantage Contract (H-Contract H0543) at a 4 (plus+) Star performance on all membership within those plans and ensuring the strategy is carried out.  This contract crosses markets, LOBs and market CEOs; therefore the Associate Director of Quality Performance must ensure all stakeholders are coordinating to drive high quality performance. 
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.


Primary Responsibilities:
  • 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

Required Qualifications:
  • 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

Preferred Qualifications:  

  • 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

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