National Director of Quality Operations and Regional Clinical Lead for Maryland,
Tampa , FL
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Job Description
National Director of Quality Operations and Regional Clinical Lead for Maryland, North Carolina and Virginia Markets for Individual Exchanges
Position Description
The National Director of Quality Operations and Regional Clinical Lead for Maryland, North Carolina and Virginia Markets for Individual Exchanges is responsible for leading quality operations and regional clinical implementations for Maryland, North Carolina and Virginia markets to support re-entry/expansion into the Individual Exchange market under an aggressive timeline with ambitious growth goals. This includes working closely with UnitedHealthcare quality leaders and the VP of Clinical Implementation and Operations of the Individual Exchanges to develop and implement the national strategy for optimizing performance on HEDIS / STAR measures. This individual will also have oversight of HEDIS / STARS reporting and coordinate the implementation and evaluation of identified CAHPS / quality improvement / HEDIS / STAR activities for all Individual Exchange plans. The Director of Quality Operations and Regional Clinical lead will leverage data and partners with Exchange leadership to develop comprehensive Key Performance Indicators (KPIs) to monitor performance of the Exchange markets, including setting clinical, quality, and affordability targets. This individual will monitor the performance of the Maryland, North Carolina and Virginia markets on these KPIs and will partner with the market's leadership and use rapid cycle quality improvement methodology to rapidly deploy new initiatives to optimize performance. The National Director of Quality Operations and Regional Clinical lead must be able to draw upon a matrixed team to drive complex business processes throughout and across the organization and will be accountable to affordability targets and contractual business requirements. This role will report to the VP of Clinical Implementation and Operations for the Individual Exchanges within Government Programs.
You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
Quality Reporting and Regulatory Compliance
*Works with UHC quality leaders to provide HEDIS / STAR reporting and to develop strategic direction to maximize performance on HEDIS / STAR measures.
*Facilitates, integrates, and / or coordinates the implementation and evaluation of identified CAHPS / HOS / quality improvement / HEDIS / STAR activities by the UHC HEDIS leads for the Individual Exchanges
*Promotes understanding, communication and coordination of all quality improvement program components.
*Coordinates reporting on quality initiatives to all appropriate committees.
Clinical Implementation and Operations
*Execute a comprehensive clinical implementation program to stand up the Maryland, North Carolina, and Virginia health plans in 2021 leveraging the UHC C&S CSP Facets platform.
*Work closely with the Enterprise Clinical Services, Operations and IT teams to build the most efficient and streamlined operating model with end-to-end clinical integration.
*Identify, articulate and prioritize initiatives to support clinical program success based on entry strategy for Maryland, North Carolina, and Virginia market, which involves direct collaboration with other enterprise clinical and non-clinical functions. These may involve partnership with a wide array of cross-functional partners such as operations, network, product, accreditation, A&G, marketing, IT and finance, among others.
Performance Management
*Establish clinical, quality, and affordability targets for the Maryland, North Carolina, and Virginia Individual Exchange markets in collaboration with the CMO, VP of Clinical Transformation and Affordability and VP of Clinical Implementation and Operations for the Exchanges.
*Monitor performance of the Maryland, North Carolina, and Virginia markets and drive targeted initiatives using rapid cycle improvement methodology to achieve optimal results.
Qualifications
*Bachelor's degree/4-year degree (Registered Nurse preferred).
*Advanced degree preferred (e.g., MBA, MPH or other related degree).
*Strong knowledge of any and/or all of the following: HEDIS, STARS, and Quality.
*3+ years' experience leading clinical operations and implementing new clinical initiatives for Medicaid and/or Exchange populations.
*Understanding of metrics, trends and the ability to identify gaps in care.
*Have held an affordability or clinical leadership position in a managed care company, public program or organization serving government entities.
*Appreciation for the individuals served by state and public healthcare programs.
*Ability to successfully work in a matrix management environment, with a proven track record of building and maintaining effective internal partnerships that lead to external client satisfaction.
*Exceptional relationship skills, with proven ability to quickly build and maintain strong relationships across diverse functions and leaders including market leaders and health plan CEOs and CMOs, C&S affordability leads, United Health Network, and CSP Facets configuration team.
*Strong strategic thinking and business acumen with the ability to align strategies and recommendations with clinical operations objectives. Adaptable and flexible style of collaborating with key stakeholders in setting direction.
*Excellent presentation skills, with experience presenting on high profile initiatives and results to executive leaders.
*Ability to lead and motivate people to achieve agreed-upon results, with a focus on driving disciplined, fact-based decisions and executing with discipline and urgency.
*Ability to balance multiple accountabilities and organizational change.
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.
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Job Summary
Company
UnitedHealth Group
Start Date
As soon as possible
Employment Term and Type
Regular, Full Time
Work Hours (i.e. shift)
Day Job
Required Education
Bachelor's Degree
Required Experience
3+ years