ASSOCIATE DIRECTOR CLINICAL QUALITY
Director Clinical Quality
We are currently seeking a Director, Clinical Quality to work for our Kansas state plan.
The Senior Director of Clinical Quality, Community & State, is primarily responsible for organizational development and planning of an integrated multi-disciplinary quality improvement structure that will effectively monitor support and lead quality improvement initiatives. This individual must exhibit the necessary leadership and management skills as well as the ability to utilize both internal and external resources to accomplish the goals and objectives of the Quality Improvement Plan (QIP) in support of government programs. Positions in this function include those responsible for supporting a variety of functions in areas such as health clinical quality program implementation throughout the organization that includes but is not limited to improvement, monitoring and assessment; HEDIS improvements; NCQA accreditation; quality regulatory compliance; and oversight of quality of care/service issues resolution. Also responsible for identified processes in clinical quality improvement and management programs including accreditation and regulatory requirements.
Specific responsibilities include:
- Establish and maintain a Quality Improvement program that encompasses all government programs
- Develop and implement training programs designed to improve the performance of government programs with state and federal regulatory requirements and business plan
- Prioritize areas of business risk and incorporate into the strategy of the quality improvement plan
- Coordinate quality efforts between Shared Services and other United segments to leverage strengths and ensure a collaborative approach to achieving efficiencies in improving outcomes
- Develop, coordinate and lead corporate quality committees operational standards and P&Ps to meet the objectives of a government program QIP
- Identify opportunities and best practices to standardize processes to improve efficiencies and health outcomes across all government programs
- Support implementation of CMS and State required clinical Quality Activities for Performance Improvement (QAPI) pertinent to all government programs
- Evaluate the effectiveness of the Quality Program by organizing the delivery and evaluation of annual customer satisfaction surveys for government programs
- Monitor and respond to regulatory changes related to quality
- Recommend opportunities for performance improvement of government programs through the tracking and trending of aggregate data related to quality and performance metrics (HEDIS scorecards report cards and dashboards)
- RN with active, unrestricted license
- Bachelors degree in sciences health-related field or business management essential
- Managed Medicaid Health Plan experience required
- LTC or experience with Managed Long term care programs
- Experience with URAC and NCQA required
- Certified Professional in Healthcare Quality (CPHQ) preferred
- Knowledge of CMS as well as numerous State Medicaid requirements
- Experience in preparing for and leading accreditation surveys
- Demonstrated project management experience required
- Excellent communication skills and ability to drive results in a highly matrixed organization.
UnitedHealthcare Community & State is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.
If you're ready to help make health care work better for more people, you can make a historic impact on the future of health care at UnitedHealthcare Community & State.
We contract with states and other government agencies to provide care for over two million individuals. Working with physicians and other care providers, we ensure that our members obtain the care they need with a coordinated approach.
This enables us to break down barriers, which makes health care easier for our customers to manage. That takes a lot of time. It takes a lot of good ideas. Most of all - it takes an entire team of talent. Individuals with the tenacity and the dedication to make things work better for millions of people all over our country.
You can be a part of this team. You can put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered.
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
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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