United Healthcare Internships – Director, Clinical Quality

Job Description:

As the Associate Director of Clinical Quality, you will be challenged to leverage your clinical, operations and program management skills to lead programs that focus on improving HEDIS® rates and impacting the quality of care for our members.

This position is responsible for providing direction and guidance on clinical quality improvement and management programs including the financial, planning, operational, and staffing components. In this role you will partner with leadership and program leads to understand the drivers and manage operational capacity and capital planning, forecast and workforce monitoring. You will lead related planning efforts to support strategic business models and program expansions or contractions as we prepare for the future of HEDIS® As a key resource, you must maintain a high degree of accuracy along with attention to detail, an aptitude for persistence, consistence & perseverance, excellent verbal and written communication skills, strong interpersonal skills, and the ability to deliver on time. Success in this role will require ability to prioritize, multitask, plan, as well as being flexible, resourceful, and selfdriven.

Job Responsibilities:

• Identifies and resolves technical, operational, and organizational problems outside own team
• Develops functional, market level, and/or site strategy, plans, production and/or organizational priorities
• Owns an end to end process
• Impact of work is most often at the operational or local business unit or market level
• Leads the quality member outreach team for initial outreach of members related to quality measure gaps in care, administrative intake of members or managing the admission/discharge information postnotification to close quality gaps in care, and collaboration with clinical and BH teams. Includes managing team incoming/outbound calls, managing requests for services from providers/members, providing information on available network services and transferring/referring members as appropriate to clinical staff/case management
• Product, service, or process decisions are most likely to impact entire functions and/or customer accounts (internal or external)
• Leads the clinical practice consultant (CPC) team assigned to contracted providers with analyzing member care, trending quality compliance at the provider level, and developing action plans and programs to support provider practices in continuous quality improvement using approved clinical practice guidelines, HEDIS® measures and other tools. Profiles network provider performance on assigned measures and outreach to underperforming providers for focused quality improvement projects, coordinates quality of care followup with leadership. Provides education regarding the quality improvement program, performs analysis and review of quality outcomes at the provider level, monitoring, measuring, and reporting on key metrics to assist providers in meeting quality standards, state contractual requirements and pay for performance initiatives. Ensures training, continuing education and HEDIS® medical record collection staff requirements are met and maintained
• Provides leadership to and is accountable for the performance of managers and/or professional staff

Job Requirements:

• Ability to analyze problems, draw relevant conclusions, and devise and implement an appropriate plan of action
• Ability to solve process problems crossing multiple functional areas and business units, experience in bringing together crossfunctional teams to complete program implementations
• Knowledge of Health Information Exchanges (HIE), Electronic Medical Records (EMRs), and other Practice Management Software
• Ability to travel to Virginia as needed/requested for providerfacing meetings/events and team meetings
• Proficient Microsoft Office skills with exceptional analytical and data representation expertise; Advanced Excel, Outlook, and PowerPoint skills
• Excellent knowledge of the Medicaid market
• Advanced knowledge base of clinical and quality standards of care, preventive health, HEDIS® measures, and regulatory processes

Qualification & Experience:

• 3+ years of experience working in the community, including face to face with providers and across specialties (Primary Care and Behavioral Health)
• 3+ years of experience working on programs for patients/members with complex care needs, including chronic conditions and/or behavioral health conditions
• 5+ years of healthcare industry quality improvement/performance improvement experience
• 3+ years of experience making formal presentations in front of committees and work group environments and using virtual technology (e.g., Microsoft Teams/WebEx)
• NCQA Certified Content Expert Certification CPHQ Certification
• Master’s degree in nursing, public health, or similar area
• Bachelor’s degree in nursing, public health, or with similar focus, or equivalent experience
• 3+ years of experience working with accreditation with regulatory processes (NCQA, EQRO etc.)
• Project management experience Six Sigma training

Job Details:

Company: United HealthCare

Vacancy Type: Full Time

Job Location: Richmond, VA, US

Application Deadline: N/A

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