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VP Clinical Quality, RN HEDIS/STARS-San Antonio, TX 10k Sign On
UnitedHealth Group • Houston, TX
Posted 9 days ago
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 has responsibilities for Quality Performance Improvement activities for WellMed Medical Management across multiple geographies regarding HEDIS/STAR ratings. Serves on multiple Optum Clinical and Quality Committees and leadership teams designed to provide strategic direction for all local care delivery groups within Optum.
Provides strategic direction, leadership and oversight for enterprise Quality performance. Responsible for planning, organizing, and directing the administration of all Quality Programs. Provides leadership to and is accountable for the performance and direction through multiple layers of management and senior level professional staff. Responsible for coordinating with appropriate personnel to meet operational program needs, ensures compliance with state/federal health plan requirements, Medicare guidelines, NCQA and health plan requirements. Provides long-term planning and oversight to ensure activities are appropriately integrated into strategic direction and operations, as well as the mission and values of the company.
- Provides leadership and support in establishing and directing the Quality Program for WellMed
- Develops and maintains policies and procedures that support the corporate initiatives that meet State, Federal legal requirements and standards
- Collaborates with physicians to execute the implementation of the clinical quality data initiatives as defined by enterprise and/ Optum LCDO
- Provides expertise to the training department on HEDIS / STAR measures and tools that support collection of and communication about HEDIS / STAR to the enterprise
- Develops HEDIS / STAR member and provider engagement strategies
- Collaborates with WellMed executive team to execute HEDIS / STAR strategies
- Works with Optum LCDO Quality leadership team to provide HEDIS / STAR reporting and to develop strategic direction
- Facilitates, integrates, and/or coordinates the implementation and evaluation of identified quality improvement / HEDIS / STAR activities as requested by UHG / UHC or related companies
- Promotes understanding, communication and coordination of all quality improvement program components
- Participates in requested evaluations and audits for UHC and other health plans
- Coordinates reporting on quality initiatives to all appropriate committees
- Assists with the development of the QM and UM Work Plan, Evaluation and the monitoring of Work Plan activities as they relate to clinical Performance Improvement
- Participates in various teams, committees and meetings at any level required to maintain business necessity
- Maintains QI program documents, reports, and committee minutes and follows all internal privacy and confidentiality policies and procedures
- Maintains current knowledge of regulatory requirements associated with the QI program
- Oversees HEDIS data submission process to all contracted health plans
- Leads accreditation efforts as defined by enterprise
- Leads the coordination and completion of projects with cross-functional teams and senior leaders across medical/nursing/clinical functional areas to achieve targeted clinical strategic performance goals
- Oversees medical / nursing / clinical workflow mapping, performance monitoring, and coaching site visits in clinic settings using process improvement methodologies to identify workflow gaps and establish future-state recommendations
- Directs medical / nursing / clinical best practice identification and standardization adoption in clinical settings with cross-functional teams and senior leaders
- Directs and promotes clinical support for clinic staff and nursing roles (RN / LVN Health Coach) with subject matter expertise and resources for population management, nurse advocacy and development opportunities, and nurse coaching / feedback programs
- Master’s degree in Healthcare or Business Administration required (8 additional years of comparable work experience beyond the required years of experience may be substituted in lieu of a Master’s degree)
- Active and unrestricted Registered Nurse license in Texas or ability to obtain within 90 days post hire
- 8+ years of management-level experience in managed care Quality programs required
- 5+ years of experience at the Director level or above
- Demonstrate knowledge of the business environment and business requirements (e.g., strategy changes, emerging business needs)
- Knowledge of NCQA HEDIS requirements and CMS STAR requirements
- Ability to establish and maintain effective working relationships with employees, managers, healthcare professionals, physicians and other members of senior administration and the general public
- Excellent verbal, written communication, presentation, and facilitation skills
- Knowledge of fiscal management and human resource management techniques
- Ability and willingness to travel both locally and non-locally as determined by business need
Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 90,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity 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.