Manager of Clinical Quality - Remote - Rhode

Manager of Clinical Quality - Remote - Rhode Island

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At United Healthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

If you are located within commutable distance of Warwick, RI, you will have the flexibility to work remotely
* as you take on some tough challenges. Travel is required about 10% of the time in Rhode Island.

• Oversee and manage health Plan Accreditation (e.g., trilogy documents such as program description, workplan, evaluation)
• Oversee and manage health equity accreditation (e.g., action plan, evaluation)
• Develop and oversee future accreditations
• Develop, implement and maintain policies and procedures
• Oversee and manage member and provider newsletters/ handbooks to ensure they are continuing to meet NCQA guidelines
• Work with external vendor to conduct provider access surveys. Analyze results and develop mitigation plans
• Review and coordinate approvals for clinical practice guidelines
• Monitor and present on provider credentialing and recredentialing
• Oversee and manage quality committees (e.g., PAC, CAC, QMC). This includes prep and post calls, agenda and meeting materials, meeting minutes, and etc.
• Oversee and manage state reporting and submissions (e.g., QIPs/ CAHPS/ etc.)
• Meet and present quality information regularly to state partners and UHC Board of Directors
• Oversee and manage provider and member facing programs at the RI level
• Develop and maintain positive relationships external state organizations within the scope of Quality Improvement
• Oversee and manage state audits (e.g., EQRO)
• Develop and get state approval for member and provider facing materials
• Coordinate work within C&S quality (i.e., local, regional and national) in order to improve performance and to close gaps in care
• Collaborate across business segments to achieve goals and targets
• Other activities as they may apply

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.

• 3+ years experience with HEDIS and NCQA - this includes HEDIS and or NCQA project experience including audit and project management of the submissions to the state and NCQA
• 3+ years of experience with health plan accreditations such as health plan, health equity, health equity plus and long term services and supports distinction
• 3+ years of experience with outside audit organizations such as EQROs
• 3+ years of QI project experience with QIP and PIPs (quality improvement projects)
• Leadership experience (e.g., Review work of others, Serve as an expert in their field, Serve as a mentor and leader, Lead functional or segment teams or projects, Motivate and inspire team members)
• Experience with managed care and insurance industry
• Experience in writing reports and analyzing performance data
• Experience creating detailed reports and project management
• Ability to travel 10% of the time in Rhode Island
• Resides within commutable distance of the Rhode Island office

• Certified Professional in Healthcare Quality (CPHQ) certification
• 3+ years demonstrated management experience with responsibility for team performance management
• Quality improvement experience within a health plan
• Clinical experience / background
• Experience with corrective action plans
• Performance driven
• Ability to make independent decisions
• Change management experience and demonstrated skills
• Demonstrated staff development skills
• Solid team building, collaboration and motivational skills
• Results-oriented
• Ability to work in a fast-paced environment
• Experience with excel (working with pivot tables) and creating PPT…