- Manages Quality Coordinators, Clinical Quality Consultants (CQC) I, II and Senior CQC and is responsible for the overall success of the market's HEDIS/Star results for contracted physicians
- Responsible for all aspects of staff development to include hiring, training, coaching and development
- Maximizes staff performance and technical expertise through clearly defined objectives, training, skill development and leadership to ensure quality services to all customers
- Delegate, monitor and control work progress on key HEDIS/Star metrics, initiatives/action plans, staff productivity, and administrative expenses
- Participates in development and implementation of systems and processes that support quality operations
- Maintains effective cross functional services by working effectively with the Medical Director, Market Medical Director, Market Operations, Regional Team, Clinic Operations and other corporate departments
- Handles complex and/or difficult provider inquires and/or problems and facilitates resolution of provider issues. Continuously strive to ensure that favorable relationships are maintained while ensuring the interest of the organization
- Takes ownership of total work process and provides constructive information to ensure physician partners have support to meet initiatives
- Analyzes data while collaborating and/or participating in discussions with colleagues and business partners to identify potential root cause of issues
- Demonstrate understanding of providers' goals and strategies in order to facilitate the analysis and resolution of their issues
- Work with relevant internal stakeholders to identify obstacles and barriers identified by providers, and methods for removing them
- Communicate and advocate providers' needs to internal stakeholders in order to drive creation of solutions that meet our HEDIS/Star goals
- Communicate industry and company information to providers through various means (e.g., newsletters; emails; outreach calls; teleconference; conferences; on-site meetings)
- Develops and coaches staff to facilitate strategic business meetings with physician groups and their staff
- Guides, oversees and ensures competency of the Quality market staff
- Assist corporate and local education team and provides input on tools used to education quality staff and other local provider support staff
- Ensures all education objectives are being met, both on a formal and ad-hoc basis
- Responsible for ensuring the quality staff is responding to market operation and provider inquiries
- Facilitates provider discussions and assists in negotiating resolution to escalated provider issues with the capability to determine if/when issues require escalation
- Collectively works with cross functional leadership to eliminate duplication of efforts and member or provider abrasion
- Includes up to % local travel
- Performs all other related duties as assigned
- 5+ years of related experience in Quality/HEDIS/CMS Stars, and ICD10/CPT/CPT II coding knowledge, Provider Relations
- 2+ years supervisory experience
- Solid working knowledge of Medicare quality operations including HEDIS, Stars, Coding and Medicare Advantage
- Knowledge of state and federal laws relating to Medicare
- Proven ability and willingness to travel, both locally and non-locally, as determined by business need
- Proven exceptional analytical and data representation expertise
- Proven advanced Microsoft Office skills. Must be proficient in Excel
- 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)
- Ability to push or pull heavy objects using pounds of force
- Ability to properly drive and operate a company vehicle
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Manager Quality Operations - Athens, United States - UnitedHealth Group
Description
Opportunities at WellMed, part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinical staff and non-patient-facing roles, you can make a difference with us as you discover the meaning behind Caring. Connecting. Growing together.
The Quality Manager is responsible for driving consistency in program implementation designed to facilitate a minimum of a 4 Star quality rating. These initiatives should result in contracted network being able to understand and support the vision to change the face of healthcare delivery for seniors. This will drive the financial viability of the market HEDIS/Star program and provide a full quality of care for the members. The responsibilities of this position demand a wide range of capabilities including: strategic planning and analysis skills; strong understanding of HEDIS and coding; management breadth to direct and motivate; highly developed communication skills; and the ability to develop clear action plans and drive process, given often ambiguous issues with numerous interdependencies. This position will facilitate any unresolved issues that remain as a result from following the standard process.
Primary Responsibilities:
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:
Preferred Qualifications:
Physical & Mental Requirements:
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.
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.
