Senior Director of Quality Management – UnitedHealthcare Community Plan of Texas
Texas Location Preferred - Virtual
The Senior Director of Quality Management provides strategic leadership and direction for the quality improvement and management program(s) as a core service to UnitedHealthcare Community Plan of Texas.
The Senior Director reports directly to the health plan’s Chief Medical Officer. Other key collaborators include the Health Services Director of Clinical Operations, the Directors of Complex Care Management, the Director of Alternative Payment Models, the Executive Directors of the various Texas Medicaid products, and the Chief Financial Officer.
The Senior Director of Quality Management works within highly matrixed relationships to lead and develop the overall quality strategy for the plan, insuring the quality program is proactive, continuously improving, applies to all product and programs within the state, and includes both quality management/regulatory adherence and quality improvement.
•Oversees the development and implementation of plan quality program including creating strategic partnerships with internal and external stakeholders to ensure a holistic and comprehensive quality program. Quality focus will span multiple Texas Medicaid products (STAR, CHIP, STAR+PLUS, STAR Kids, MMP) for large statewide managed Medicaid membership.
- Significant emphasis will be placed on facilitating health plan clinical and operational activities to support retention of at-risk premium revenue related to the state Medicaid regulator’s Pay-for-Quality program, and to support quality performance in our health plan’s value-based care provider contracting arrangements.
- Near-term focus will include preparatory work for NCQA LTSS (long-term services and supports) Distinction and for NCQA’s distinction in Multicultural Health Care, both of which are scheduled to occur over the next year.
•Works to coordinate the work across HEDIS Operations, Data Analytics and Reporting, Accreditation, Member Surveys, Regulatory Adherence, Member Engagement, Medical Quality Applications, and other matrix partners, utilizing the expertise, standard process, and capabilities of these areas to enhance quality program performance of the plan.
•Creates a comprehensive Quality Improvement plan, playbook and quality targets that links to contractual and regulatory obligations, value based contracting and other HP identified initiatives.
•Oversees and directs as applicable quality improvement activities and interventions.
•Ensures strong HEDIS performance.
•Cultivate a strong working relationship across business segments to attain or maintain the Plan’s compliance with accreditation standards and contractual requirements as they apply to quality.
•Develops and maintains positive relationships with State Agency stakeholders and State External Quality Review Organization within the scope of Quality Management and Improvement.
•Oversees and insures the completion, integration, maintenance, approval, and submission of the trilogy document, including but not limited to Quality Program Description, Work Plan, Evaluation, and Program Policies and Procedures.
•Provide, through partnership with the Chief Medical Officer, strong leadership for the local quality team and integration with the Texas Community and State clinical organization to meet the overall strategic quality goals of the HP.
- Bachelor’s Degree
-5+ years of experience in leading an integrated and progressive quality health care organization, preferably within managed care industry
-5+ years of experience with demonstrated functional knowledge, process improvement initiatives, and performance measurement of quality
-Strong, independent decision maker and risk taker
-Excellent written and oral communication skills with internal and external partners and employees
-Strong influencing and negotiation skills
-Strong process and project management skills, as well as change management experience and demonstrated skills
-Demonstrated staff development skills, team building, collaboration, and motivational skills
-Strong preference for Texas-licensed registered nurse, physician or physician’s assistant or a Certified Professional in Healthcare Quality (CPHQ)
-Expert knowledge of the managed care/health insurance industry, products, and services
-Advanced degree in business administration, healthcare management or public health a plus
Colorado Residents Only: The salary/hourly range for Colorado residents is $110,200 to $211,700 base. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.
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.