As a Medicare Quality Manager you will manage and oversee quality-of-care improvement projects and reporting for United Healthcare Community Plan of Arizona focusing on Medicare STAR reports for Medicare members with special needs and dual Medicaid coverage (DSNP).You will work with local, regional and national quality teams and analytic groups, highlighting Arizona-specific projects and reports. You will lead innovation and manage local projects and managing in-state parts of national initiatives. You will work with many departments locally and nationally to improve healthcare quality. You will meet with provider groups and state and community agencies for joint projects and initiatives, make presentations to senior leadership, ensure project documentation is accurate and ensure projects are completed on time and within scope.
Are you a subject matter expert in project management, scope definition, risk identification, methodology and resource allocation or facilitation? Assist us with leading strategic initiatives crossing business teams and operating groups as a Medicare Quality Manager to coordinate and complete projects, define performance and results and manage vendors and service providers. Pertinent data and facts will be reviewed to identify and solve issues and mitigate risks, prioritize your work load and work on ad hoc projects as assigned.
This position is located on-site at 1 East Washington Street in Phoenix, AZ with a potential to work from home 1-2 days per week after training based on business needs.
- Manage STARS improvement projects with year-round monitoring and annual required reporting. Supports STARS, HEDIS and related metric reporting where applicable
- Manage and mentor a team of staff who outreach to providers for gaps in care and audit support
- Provide subject matter expertise in areas including project scope definition, risk identification, project methodology, resource allocation, facilitation, and other areas of expertise based on established project management techniques
- Support Health Plans as Subject Matter Expert of STARS and HEDIS Technical Specifications, project plans, and reporting logistics
- Work with Health Plans and vendors to review their programs and processes and develop data collection strategies, reports and outcomes. Reviews data systems related to reporting
- Coordinate with IT group the set-up of STARS measurement for market level reporting; This includes assessment of code mapping, provider mapping, billing systems, member benefits and payment mechanisms; as well as providing analysis of impact on performance scores based on STARS programs and criteria
- Perform data support and evaluation of performance; Extracting, manipulating, and interpreting data from STARS program repository
- Support the evaluation and monitoring of State specific QM Metrics
- Identify and implement opportunities to improve rates or efficiency of data collection
- Identify and review claims data
- Identify alternative sources for administrative data
- Perform data completeness evaluations and ad hoc QM data studies
- Attend weekly/monthly and adhoc Webex meetings with national partners
- Travel in-state to meetings with providers, state or community agencies to manage projects and give reports
- Travel regionally or nationally for training/meetings with other parts of the company or to meet with provider groups and healthcare quality or policy organizations
- Make presentations to management on project updates, project cycle, and expected results
- Ensure projects are completed on time and in scope
- Bachelor’s degree in Business, Healthcare Administration, Public Health or other related field or 3+ additional years of equivalent experience
- 3+ years of experience working in a healthcare environment
- 2+ years of STARS or similar program experience
- 2+ years of experience managing staff
- 3+ years of experience with project management
- 3+ years of experience in tracking, working with large data sets and making data-driven analytical decisions
- Intermediate or higher level of proficiency with Excel and PowerPoint, including visual representation of quality data and trends, use of basic math and statistics functions
- 2+ years of experience preparing and writing project reports, funding requests, other narratives
- 2+ years of experience making public presentations, reporting to small to medium size groups
- Proficiency with Tableau
- Experience acting as a liaison between business and technical teams
- UnitedHealth Group, Optum, or UnitedHealthcare experience
- Community & State and or Medicare & Retirement experience
- Six Sigma / Lean or CPHQ certification
- PMP certification
- Demonstrated ability to communicate ideas clearly and concisely
- Experience working in a timeline driven environment prioritizing and balancing multiple priorities
Careers at UnitedHealthcare Community & State. 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. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place 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.
Keywords: Quality Manager, STARS Manager, Project Manager, Medicare Manager, Medicare,HEDIS, healthcare, STARS, public health, managed care, project management, quality measures, Tableau, Six Sigma, CPHQ, PMP, UHC, UHG, Optum, UnitedHealthcare, Phoenix, AZ, Arizona