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About UHG

Careers at UnitedHealth Group

 

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:

Medical and Clinical Operations

Country:

US

Postal Code:

96801

Approximate Salary:

Not Specified

Position Type:

Full Time

Quality & Credentialing Special Projects Manager - Honolulu, HI

UHG - Honolulu, Hawaii

Posted: 10/20/2018

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)

 

The Quality and Credentialing Special Projects Manager is responsible for following key quality functions with United Healthcare Community Plan of Hawai’i. The person in the role will be responsible for leading, coordinating, monitoring and maintaining the requirements for the credentialing and re-credentialing process and any other assigned special projects along with providing delegation oversight, implementation support, measurement standards, and revisions as needed that incorporate applicable best practices with proven outcomes.

 

Primary Responsibilities:

  • Manage special quality activities and credentialing/re-credentialing oversight, consistent with regulatory requirements per the Department of Human Services/Med-QUEST Division (MQD), Centers for Medicare and Medicaid Services (CMS), and the National Committee on Quality Assurance (NCQA)

  • Serve as a Liaison to vendor(s) and/or internal/external stakeholders to ensure timely completion of projects

  • Development of strategy and action plan to address any assigned corrective action plan

  • Provide oversight to credentialing, re-credentialing and special projects, policies and procedures, recommending, and editing new policies as needed. Review and edit policies and procedures to ensure content is aligned with regulatory requirements and national policies. Monitor and respond to ongoing changes in regulatory requirements

  • Responsible for providing oversight for any delegated function pertaining to credentialing/re-credentialing and any other special projects

  • Coordinate with the Health Plan leadership and national representatives to ensure compliance with credentialing and re-credentialing processes

  • Present updates, reports, etc. to Quality Committees as needed


Required Qualifications:

  • Bachelor’s degree or 5+ years of equivalent applicable experience

  • 1+ year of experience in health care field

  • Knowledge of regulatory agencies including NCQA

  • Experience with MS Word, Excel, PowerPoint, Outlook

Preferred Qualifications:

  • Master’s degree or higher

  • 1+ years of experience working in a health plan, hospital, or office setting in Quality Management

  • Experience with credentialing and re-credentialing processes

  • Experience providing oversight to manage programs, projects, etc.

  • Experience with interpreting quality standards, contracts and letters of direction

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, QI, Quality Improvement, QA, Quality Assurance, Credentialing, Credential, NCQA, quality standards, regulatory, project management, project manager, letters of direction, Honolulu, HI, Hawaii

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