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Director Quality Operations East Coast in Florida at UnitedHealth Group

Director Quality Operations East Coast in Florida

UnitedHealth Group Charlotte, NC (On Site) Full-Time

Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life’s best work.(sm)



The Director Quality Operations provides strategic leadership and direction for the quality improvement program to the local market. The Director of Quality Operations works within highly matrixed relationships to develop and operationalize the overall quality strategy for the market ensuring the quality program is proactive, continuously improving to include quality management / improvement and regulatory adherence. This position provides insight and direction to the market to align with a changing healthcare landscape as it applies to quality. 



Position in this function is responsible for driving and executing strategy to ensure optimal HEDIS / CMS Star results. Responsibilities including but not limited to HEDIS, CAHPS, HOS Standards, and Quality initiatives related to appropriate coding,, driving deployment and relentless day to day operational monitoring of region / market as applicable. The improvements will drive increased HEDIS / Star Ratings.  This includes partnering closely with the Sr Director of Quality, QRA Medical Director, and local market Cross functional leadership.  



The Director of Quality Operations is the population health expert for the market and assesses gaps in programs and disparities, proactively communicating the needs and driving innovation to find programs to work at the local or market level.  The Director understands and influences Member and Provider Engagement Programs deployed in the market and assures day to day oversight to close member gaps in care.



If you are located in East Coast, FL Treasure Coast, Orlando, Fl Jacksonville, FL, you will have the flexibility to work remotely* as you take on some tough challenges. 



Primary Responsibilities:




  • Drives programs and initiatives to assure member access to care and gaps in care closure

  • Partners with VP of Quality, QRA Medical Director, and local market Cross functional leadership to ensure established quality goals are met

  • Manages assigned market / state Quality Improvement goals to drive and track data capture and collection, provider engagement and value based contracting, member engagement programs, clinical, and customer care touch points

  • Aligns and coordinates deliverables within their market / region and among the team including but not limited to:  CMS Star program, HEDIS data collection, Data Analytics and Reporting,  CAHPS Member Surveys, HOS member surveys, ICD10/CPT/CPT II coding capture related to Quality initiatives, and Regulatory Adherence, and Member/Provider Engagement 

  • Display innovative problem solving and upholds principles of continuous quality improvement

  • Meet annual goals and objectives for the market and key metrics in conjunction & under the direction of the VP of Quality, cross functional teams and corporate goals and strategies to meet and exceed established program objectives

  • Monitors daily, weekly, monthly, quarterly, semi-annual and annual reports against goals to assess program success and alignment and to identify opportunities for improvement

  • Assists with Quality Strategy Business Plan 

  • Knowledge of the Quality Improvement, CMS/Star Rating information and updates, NCQA/HEDIS,  and gap metrics for assigned market

  • Appropriate application to form information to strategy to drive the market to excellence

  • Performs all other related duties as assigned





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.


Required Qualifications:




  • BA / BS degree in healthcare related field Bachelor’s degree in Nursing, Ancillary Health Care, Health Care Administration, Business Administration, Public Administration, or a related field required.  (Associate Degree with 5 additional years of comparable work experience beyond the required years of experience may be substituted in lieu of a bachelor’s degree)

  • 5+ years of leadership or managerial experience. Management of process or discreet work stream is acceptable

  • 3+ years of experience in, and/or knowledge of, Clinical Quality and Quality Improvement processes required NCQA/HEDIS, CMS Star Program , ICD10/CPT/CPT II coding and CAHPS/HOS 

  • Advanced  knowledge of Microsoft Office applications required, including, but not limited to, Word, Excel, Visio and PowerPoint



Preferred Qualifications:




  • Advanced degree, Masters (MBA, MHA, MPH, MS or related field)

  • Clinical Registered Nurse or other related clinical experience or education

  • Certified Professional Healthcare Quality (CPHQ)

  • 5+ years of working in managed care or a healthcare delivery system 

  • Project Management experience

  • Solid knowledge base of clinical standards of care, preventative health and STAR measures

  • Solid financial analytical background within Medicare Advantage plans (Risk Adjustment/STARS Calculation models)

  • Superior verbal and written communication skills; conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others 

  • Proven problem-solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action 

  • Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation



Physical & Mental Requirements:




  • Ability to lift up to 10 pounds

  • Ability to sit for extended periods of time

  • Ability to stand for extended periods of time

  • Ability to use fine motor skills to operate office equipment and/or machinery

  • Ability to receive and comprehend instructions verbally and/or in writing

  • Ability to use logical reasoning for simple and complex problem solving





To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment



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 550,000+ 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)



WellMed was founded in 1990 with a vision of being a physician-led company that could change the face of healthcare delivery for seniors. Through the WellMed Care Model, we specialize in helping our patients stay healthy by providing the care they need from doctors who care about them. We partner with multiple Medicare Advantage health plans in Texas and Florida and look forward to continuing growth.



*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy





Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.



OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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