Senior Director, Clinical Quality - Elkridge, MD

UnitedHealth Group Incorporated

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.
 
UnitedHealthcare Quality Management & Performance is an integrated team serving all UnitedHealthcare businesses, focused on improving the health of our members, enhancing our operational effectiveness, reinforcing brand and reputation for high-quality health plans and helping members lives healthier lives.

Quality Management & Performance combines talented individuals from many areas of quality, including HEDIS, CAHPS and Accreditation. Our goal is extraordinary performance that exceeds the expectations of the constituents, customers and members we serve.

 

We are looking for a Senior Director, Clinical Quality to join our team in Elkridge, Maryland.
 
This position provides strategic leadership and direction for the quality improvement and management programs as a core service to Community & State Plans. The Director 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. This position provides strategic insight and direction to the plan to align with a changing health care landscape as it applies to quality. The plan director is an active contributor in RFP responses, taking lead on the quality portion. This position develops and maintains strong relationships with state regulators, provides leadership input to expand and support provider engagement, and advocacy at the state level. This position coordinates across multiple functional areas including but not limited to: Clinical, Physician Engagement, Member Experience, Benefit Design/Product, Compliance, Network, Behavioral Services, and Pharmacy as needed to support the quality outcomes.

Job Components:

Quality Improvement
Quality Management/Regulatory Adherence
Advocacy and Relationship Management, Internal and External
Fiscal Management
Employee Engagement and Development

Major Responsibilities

 

• Oversees the development and implementation of plan quality program
• Works to coordinate the work within the QMP Centers of Excellence for: HEDIS Data Collection, Data Analytics and Reporting, Accreditation, Member Surveys, Regulatory Adherence, and Member Activation and Engagement. Utilizing the expertise, standard process, and capabilities of these areas to enhance quality program performance of the plan.
• Partners to develop Quality Improvement plan playbook and quality targets.
• Oversees and directs as applicable quality improvement activities and interventions to close gaps in care and improve outcomes for identified critical quality measures.
• Ensures strong HEDIS performance.
• Collaborates 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 creation, 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.
• Oversees and insures the creation and submission of reports to meet state contractual requirements including Performance Improvement projects (PIPs)
• Insures and oversees Health Plan Quality Management /committee structure and integrated quality oversight processes.
• Oversees and directs as applicable process improvement plans and corrective action plans for surveys, accreditations, EQROs, and state audits, within the scope of Quality Management and Improvement.
• Represents and gives input to the RFP process as it applies to quality.
• Interviews, hires, and supervises quality department staff.
• Develops, mentors, and coaches staff.

Requirements:

 

• BS/BA in related field or RN and equivalent experience, advanced degree a plus.
• 8-10 years of experience in leading an integrated and progressive quality organization, preferably within health care industry.
• 8+ years of significant leadership and managerial experience.
• Relationship focused.
• 8+ years of experience with demonstrated functional knowledge, process improvement initiatives and organizational behavior.
• Performance Driven.
• Excellent written and oral communication skills with internal and external partners and employees.
• Strong influencing and negotiation skills.
• Strong, independent decision maker and risk taker.
• Strong change management experience and demonstrated skills.
• Strong process and project management skills.
• Demonstrated staff development skills.
• Strong team building, collaboration and motivational skills.
• Results-oriented.
• Expert knowledge of the managed care/health insurance industry, products and services (preferred).
• Comprehensive understanding of functional areas and the impact in performance and performance measurement of quality.
• CPHQ preferred.

 

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 17 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.^SM

Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability status.




UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.

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