If you want to achieve more in your mission of health care, you have to be really smart about the business of health care. Challenge yourself, your peers and our industry by shaping what health care looks like and doing your life's best work.(sm)
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.Primary Responsibilities:
- Management of staff
- Sets team direction, resolves problems and provides guidance to members of own team.
- Perform oversight of all QPA activities, monitor performance and ensure compliance with business requirements and job responsibilities
- Guide professional development of the QPA team, to include addressing performance concerns and issues
- Ensure appropriate staffing levels; interview, hire, and onboard HPM staff as needed
- Interview, hire, onboard and manage contractor staff as needed
- Lead analysis of project outcomes to generate data driven recommendations for process improvement
- Monitor on-going progress of business processes
- Monitor compliance against relevant process requirements (e.g., turnaround time)
- Ensure all NCQA, CHCA, FEHB, State and other HEDIS® reporting requirements and deadlines are met
- Demonstrate understanding of relevant organizations' operations, products and applications, strategies, processes, and/or business priorities in order to build effective solutions including development of project plans (e.g., communication plans; implementation steps) to support operations using relevant tools and databases
- Adapts departmental plans and priorities to address business and operational challenges.
- Develop policies, procedures, and guidelines for Quality Operations Engagement activities
- Review/approve policy and process changes
- Evaluate regulatory changes and determine steps needed to implement in programs
- Identify and implement business development opportunities to support growth of department and achieve objectives
- Oversee/navigate technology and software applications utilized in the delivery of services
- Influences or provides input to forecasting and planning activities.
- Product, service or process decisions are most likely to impact multiple groups of employees and/or customers (internal or external).
- Analyze business process information (e.g., metrics; analytics) to identify key issues, trends, and potential root causes (e.g., training issues; lack of understanding by user community) that point to improvement opportunities
- Lead workgroups to identify and implement process improvement and to ensure appropriate preparation is completed to meet business requirements
- Lead special projects as assigned, i.e. Data migration integrations, WellMed relationship, acquisition plans or other special reporting
- Lead and/or actively participate in HEDIS software testing efforts to ensure project preparedness
- Use a process driven approach to identify root cause and process improvement opportunities
- Demonstrate and remain current in understanding of relevant regulations and systems
- Complete all required training for job role and stay current on all HEDIS® technical specifications and software systems
- Develop subject matter expertise in HEDIS® software tools and HEDIS® and other required quality metric reporting specifications
- General knowledge of HEDIS® impacts for each LOB, i.e. Accreditation, STARs, FEHB, State, etc.
- Communicate potential impacts and risks associated with implementing proposed solutions to business partners and relevant stakeholders
- Timely escalation of all issues and barriers to Senior Director
- Facilitate QPA national and team meetings and ensure effective and timely communications
- Provide support to meet all CHCA (Auditor) requirements for HEDIS reporting, including support in gathering information as requested for onsite meetings, data queries, and other requirements
- Collaborate with all Quality Solutions Delivery teams, QDAR, Trainers, Regional Market staff, Vendor Consultants, Strategic Partners, CHCA (Auditors), Lines of Business and Optum (PEDS) on all HEDIS® deliverables as needed
- Summarize and communicate proposed solutions with the appropriate audiences
- Anticipates customer needs and proactively develops solutions to meet them.
- Serves as a key resource on complex and/or critical issues.
- Solves complex problems and develops innovative solutions.
- Performs complex conceptual analyses.
- Reviews work performed by others and provides recommendations for improvement.
- Forecasts and plans resource requirements.
- Authorizes deviations from standards.
- May lead functional or segment teams or projects.
- Provides explanations and information to others on the most complex issues.
- Motivates and inspires other team members
- Bachelor's Degree or higher
- 6+ years HEDIS® or CMS stars experience
- Demonstrated ability to manage and prioritize deliverables
- Healthcare experience
- Management experience with at least 5 direct reports
- Proficient in use certified HEDIS® software
- Strong leadership and interpersonal skills
- Ability to work independently
- Team player
- Strong communication skills
- Ability to manage multiple projects at a time
Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can 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.
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