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. Bring your skills and talents to a role where you'll have the opportunity to make an impact on a huge scale. This is the place to do 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.
- Manages Quality Coordinators, Clinical Quality Consultants (CQC) I, II and Senior CQC and is responsible for the overall success of the market’s HEDIS/Star results for contracted physicians
- Responsible for 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
- Responsible for 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
- Includes up to 50 - 75% local travel
- Performs all other related duties as assigned
- Bachelor’s degree in Nursing, Ancillary Health Care, Health Care Administration, Business Administration, Public Administration, or a related field required. (Associate Degree with an 4+ years of comparable work experience beyond the required years of experience may be substituted in lieu of a bachelor’s degree)
- 5+ years of related experience in Quality/HEDIS/CMS Stars, and ICD10/CPT/CPT II coding knowledge, Provider Relations
- 2+ years supervisory experience.
- Knowledge of Medicare quality operations including HEDIS, Stars, Coding and Medicare Advantage
- Knowledge of state and federal laws relating to Medicare
- Ability and willingness to travel, both locally and non-locally, as determined by business need
- Advanced Microsoft Office skills. Must be proficient in Excel
- Master’s degree in Healthcare Administration, Business Administration, or a related field required. Strong knowledge base of clinical standards of care, preventative health and STAR measures
- Project Management experience
- Strong financial analytical background within Medicare Advantage plans (Risk Adjustment/STARS Calculation models)
- Exceptional analytical and data representation expertise
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 240,000+ 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)
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: Dallas, Quality, TX, Medicare, CMS, HEDIS, Manager, Supervisor, CQC