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Job Category:

Medical and Clinical Operations



Approximate Salary:

Not Specified

Position Type:

Full Time

Manager, Clinical Quality - Ontario, CA

UHG - Ontario, California

Posted: 12/7/2018

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm)
Responsible for the day to day activities of the quality management department that provide quality improvement, denials, and appeals functions for IPA’s. Performs quality improvement activities for assigned IPAs.
Primary Responsibilities:
  • Coordinates coverage of local staffing needs, arranging coverage for sick calls and vacation planning and monitors timecard accuracy
  • Provides direct day to day oversight for all assigned staff
  • Delegates tasks to appropriate staff within the QI department
  • Responsible to oversee the completion of the QI quarterly program evaluations, monitoring improvement and compliance
  • Performs direct QI functions for local IPA, as assigned
  • In conjunction with the local Medical Director, Executive Director, and QI Director, implements quality improvement strategies
  • Day to day responsibility for the QI Programs (P4P, 5 STAR, etc.)
  • Communicates changes in policy and procedure to assigned staff
  • Participates in the interview and counseling process with assigned staff
  • Meets regularly with assigned staff to ensure performance and monitor productivity
  • Reports performance to targets and works with QI Director to develop intervention strategies
  • Provides lead communication link from denial and appeal unit to the UM department
  • Other duties required to fulfill this position, as assigned

Required Qualifications:
  • Undergraduate degree or equivalent experience
  • Current LVN or RN license with 3+ management experience
  • Knowledge of the California P4P and CMS STARs programs
  • Previous HMO experience, preferably in Quality Improvement

North American Medical Management, California, Inc (NAMM California) partnered with OptumHealth in 2012. NAMM California and OptumHealth share a common goal of bringing patients, physicians, hospitals and payers closer together in the mission to increase the quality, efficiency and affordability of care. NAMM California is a part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system. NAMM California develops and managers provider networks, offering a full range of services to assist physicians and other providers in supporting patient care coordination and their managed care business operations. For over 18 years, NAMM California has been an innovator in health care with a track record for quality, financial stability, extraordinary services and integrated medical management programs. NAMM California is well positioned to continually invest in its infrastructure and systems for the benefit of its provider clients and to accommodate the impending changes that will come forth from healthcare reform.

The NAMM California provider clients represent a network of almost 600 primary care physicians and over 3,000 specialists and work with the premier hospitals in their respective markets.


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.

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