Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life's best work.(sm)
The Director of Population Health Management is responsible for coordinating and implementing quality initiatives and overseeing projects in order to continuously improve all aspects of health care delivery for the enterprise. This position will manage teams that handle high call volumes. This includes communication and monitoring of HEDIS and STAR measures, as well as promoting culture changes that support an environment of quality. This position also establishes and improves onboarding performance metrics, business operation service development, and process design teams to promote education and cultivate relationships as well as aiding with the strategic planning for business development activities for the organization.
- Provides leadership and support in various markets in establishing and directing the Quality Program consistent with organizational activities
- Provides expertise to the training department on HEDIS measures and tools that support collection of and communication about HEDIS to new and existing markets
- Coordinates reporting on quality initiatives to all appropriate committees and ensures timely submission of data and metrics
- Partners with appropriate Medical Management and Compliance resources in completing compliance audits to ensure that state, federal, and health plan regulations meet business requirements
- Regulatory changes and new policy will initiate new or reversed processes requiring transitioning and implementing new processes within our business relations
- Accountability to market business leaders for achieving measurable targets established by the organization to achieve strategic goals and business vision
- Capable of facilitating and management of on boarding functions to develop technical skills, set performance expectations, evaluate outcomes and implement training and education efficiently and effectively
- Drive resolution of caller questions/issues on the first call whenever possible (e.g., first-call resolution, one-and-done)
- Identify and communicate steps/solutions to caller questions/issues, using appropriate problem-solving skills and established guidelines, where available (e.g., workarounds, descriptions of relevant processes)
- Demonstrate understanding of internal/external factors that may drive caller questions/issues (e.g., recent plan changes, mass mailings, call directing/rerouting, weather emergencies)
- Provide oversight and guidance on project management timelines and process improvement, implementation, and development for clinic operations in support of organizational objectives, policies, and procedures
- Improvement of efficiencies by research of best practices and identifying new/needed skills, processes, or methods to improve customer relations and business operation
- Performs all other related duties as assigned
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
- Bachelor's degree in business, Healthcare Administration or related field required (8 additional years of comparable work experience beyond the required years of experience may be substituted in lieu of Bachelor's degree)
- 7-10 years of progressive management experience in MSO operations within a Medicare/HMO organization required
- Project management and improvement skills in a managed care environment with focus on regulatory compliance required
- Experience with Microsoft Office software programs
- Understanding of financial and operational reporting with analytical skills to promote process improvement
- Problem solving capabilities resulting in significant business impact and customer satisfaction
- Demonstrate knowledge of established workflows and support processes (e.g., available resources, internal/external business partners, points of contact)
- Detail-oriented and ability to identify potential risk or problems and find resolution
- Ability to manage group practitioner relationships with diverse geographic locations, skills, and level of understanding of company processes and policy
- Effectively operate through complex organizational situations with ability to anticipate obstacles and plan appropriate approach.
- Able to influence and interact comfortably with all levels of professional and clinical staff
- Implement and manage change in an ever changing complex environment
- Excellent written and verbal skills
- This position requires call center experience or any experience with teams that handle high call volumes.
- Master's degree in a related field preferable
- Nursing with unrestricted license
Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors., WellMed is a network of doctors, specialists and other medical professionals that specialize in providing care for 550,000+ older adults with over 16,000 doctors' offices 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 Actionemployer and all qualified applicants will receive consideration for employmentwithout regard to race, color, religion, sex, age, national origin, protectedveteran status, disability status, sexual orientation, gender identity orexpression, marital status, genetic information, or any other characteristicprotected by law.
UnitedHealth Group is a drug-free workplace.Candidates are required to pass a drug test before beginning employment.
Job Keywords: Data Integrity, STARS, HEDIS, Population Management, Registered Nurse, Managed Care, UHG, Optum, WellMed, San Antonio, TX