TRICARE Senior Quality Clinical Program Consultant - Phoenix, AZ
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.(sm)
This position works under the direction of the Vice President of Clinical Quality Management (CQM). Primary responsibility will be to identify and pursue opportunities to improve the quality of business operations and increase efficiencies across UnitedHealthcare Military & Veterans (UHC M&V) Clinical Services (Utilization Management, Case Management, Disease Management, Behavioral Health). Analyze, assess and interpret operational needs as related to quality management and quality improvement.
** This is a office position located at 2222 West Dunlap Avenue, Phoenix, AZ**
Responsibilities:
• Collaborates with the UHC M&V Clinical Services staff to identify, analyze and pursue opportunities for quality improvement
• Anticipates customer quality management and quality improvement needs and proactively develops solutions to meet them
• Uses a process driven approach to identify root cause and process improvement opportunities (e.g., DMAIC method, Six Sigma, Paredo charts)
• Communicates and presents opportunities, status and plans related to improvement efforts to UHC M&V leadership, business partners and service center management.
• Understands government programs business and products (TRICARE, Medicaid, Children's Health Insurance Programs and Medicare)
• Reviews and understands standard operating procedures, tools, training and systems for multiple operations.
• Supports and may lead cross functional teams in identification, development and execution of necessary improvements and change initiatives.
• Performs all other duties as assigned.
Requirements:
• Bachelor's degree in business and/or administration, with education or work experience in the healthcare field, or any appropriate combination of extensive experience and education as deemed acceptable.
• 2 + years direct experience in a change management capacity, including all aspects of process development and execution
• 2 + years experience in a project management team.
• 2 years of experience in program management including process improvement with positive outcomes.
• Six Sigma qualifications and/or experience preferred.
• Project Management experience preferred
• Advanced Business Degree preferred
• Six Sigma Black Belt or Green Belt Designation preferred
• Previous HMO/Managed Care/Healthcare/Medicare/Medicare Part C or TRICARE Industry experience highly desirable.
• RN with current, active license without restriction in required state(s), is preferred.
• PMP preferred
• Demonstrated understanding of health plan, customer centric and/or government regulatory operations.
• Read, analyze, design and interpret general business processes, standard operating and technical procedures, contract and regulatory
• Ability to analyze data and assess the financial and procedural impact of operational processes.
• Ability to communicate internally and externally with all levels of employees, including senior management.
• Able to structure an issue and analyze alternative solutions using metrics and other business data.
• Ability to think strategically and to translate strategic directives into tactical initiatives.
• Proven ability to influence course of action when others are directly accountable for outcome
• United States Citizenship
• Ability to obtain favorable adjudication following submission of Department of Defense form SF86 NAC form SF86.
As a requirement of UnitedHealth Group’s contract with the Department of Defense, this position requires U.S. citizenship and proof of favorable adjudication following submission of Department of Defense form SF86 http://www.opm.gov/forms/pdf_fill/sf86.pdf, (the National Agency Check or “NAC”). Successful completion of the NAC process is a requirement for continued employment in this role. NAC processing will be initiated by our TRICARE Security Officer post-offer, and can take 3-6 months for a final decision communication from the Department of Defense. Candidates will be allowed to begin employment with UnitedHealth Group in this role based on an interim clearance, and final results will be communicated as they are received. Failure to obtain final NAC approval will result in termination from this role.
Careers at UnitedHealthcare Military & Veterans. When it comes to their health care, the men and women who help keep the peace deserve the greatest peace of mind. That’s why UnitedHealthcare is the organization that’s called on to serve them and their loved ones. We’re all about finding better ways to help improve their lives no matter where life may take them. So our career opportunities take challenge to a higher level. If you have a commitment to quality that mirrors our commitment to the men and women of the armed forces, take time to learn more about the career paths available here. It’s a genuine opportunity to do your life’s best work.
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, or national origin.
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.
Key Words: Project Management, PM, bachelors degree, Six Sigma, quality improvement, quality, strategic, process improvements, healthcare, business operations, operations, Medicare, Medicaid, Phoenix, Arizona, AZ
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