Jobs
>
San Antonio

    RN Quality Manager - San Antonio, United States - UnitedHealth Group

    UnitedHealth Group
    UnitedHealth Group San Antonio, United States

    3 weeks ago

    UnitedHealth Group background
    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:

    Manages Quality Coordinators, Clinical Quality Consultants (CQC) I, II and Senior CQC and/or support staff (Community Health Care Worker, Transition Care Navigators) is responsible for the overall success of the market's HEDIS/Star results for contracted physicians Responsibleforallaspectsofstaffdevelopmenttoincludehiring,training,coachingand 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 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:
    4+ years of related experience in Quality/HEDIS/CMS Stars, and ICD10/CPT/CPT II coding knowledge, Provider Relations 1+ years of 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 Advanced Microsoft Office skills, proficient in Excel Exceptional analytical and data representation expertise Ability and willingness to travel, both locally and non-locally, as determined by business need

    Preferred Qualifications:
    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)

    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 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.
  • H & H Consulting

    Quality Control Manager

    2 days ago

    H & H Consulting San Antonio, United States

    Overview: · - Develops, implements, and maintains a comprehensive quality management system to ensure compliance with industry standards and regulatory requirements. · - Oversee all aspects of the cement quality control production process, including testing procedures, data analy ...

  • ZephyrTech

    Regional Quality Management Officer Administration

    3 weeks ago

    ZephyrTech San Antonio, United States

    "At the heart of life" the DOMICIL Group provides care for our residents at over 45 locations with more than 5,500 dedicated colleagues. We are a family-owned company and believe that trust is built through actions, not promises. That's why we have rules that value each individua ...

  • Satterfield & Pontikes

    Quality Manager

    2 weeks ago

    Satterfield & Pontikes San Antonio, United States

    · Due to growth and expansion we are adding a Quality Manager to oversee our Central TX region. We have projects in both the Austin and San Antonio area. In this position you will report to our Corporate Quality Manager and working very closely with the local VP. · On top of a ...

  • Lumicity

    Quality Manager

    3 weeks ago

    Lumicity San Antonio, United States

    Our client is a privately owned manufacturing firm in San Antonio that manufactures high end products, they are Looking for a seasoned Quality Manager. Drive quality control efforts, oversee inspections, and maintain excellence in manufacturing while leading a dedicated team. · R ...

  • University Health

    Manager, Quality Management

    3 weeks ago

    University Health San Antonio, TX, United States

    POSITION SUMMARY/RESPONSIBILITIES · Manages, supervises and assists the Director, Population Health Management (PHM) with oversight of short-term case management (CM) therapy services to facilitate high quality, cost effective care for Community First Health Plans, Inc. (Communi ...

  • Aegis Worldwide

    Quality Assurance Manager

    3 weeks ago

    Aegis Worldwide San Antonio, United States

    Job Title: Quality Assurance Manager · Location: Boerne, TX · Job Type: Full-time · Schedule: Monday-Thursday · About Us: Aegis Worldwide is a recruiting firm that works with clients in the manufacturing and engineering space. Our client is a leading provider of high-quality ...

  • ICF International Inc

    Quality Assurance Manager

    1 day ago

    ICF International Inc San Antonio, United States

    The Quality Assurance Manager will be responsible for oversight of all quality assurance operations related to the ORR Call Center and execution of project deliverables. The position will in coordination with operations manager new performance strategies to ensure compliance as w ...

  • ICF

    Quality Assurance Manager

    1 week ago

    ICF San Antonio, United States Paid Work

    The Quality Assurance Manager will be responsible for oversight of all quality assurance operations related to the ORR Call Center and execution of project deliverables. The position will in coordination with operations manager new performance strategies to ensure compliance as w ...

  • Microsoft Corporation

    Construction Quality Manager

    2 weeks ago

    Microsoft Corporation San Antonio, United States

    Microsoft's Cloud Operations + Innovation (CO+I) organization is the engine that powers our cloud services. Our data center construction team is dedicated to delivering the highest quality data centers for our cloud services. As we continue to revolutionize the way construction p ...

  • Lucifer Lighting

    Quality Assurance Manager

    3 weeks ago

    Lucifer Lighting San Antonio, United States

    Job DetailsLevelManagementJob LocationCorporate Office - San Antonio, TXPosition TypeFull TimeEducation Level4 Year DegreeJob ShiftDayDescriptionPosition Summary: The Quality Assurance Manager is responsible for setting best-in-class quality standards by maintaining consistent qu ...

  • ICF International Inc

    Quality Assurance Manager

    1 week ago

    ICF International Inc San Antonio, United States

    The Quality Assurance Manager will be responsible for oversight of all quality assurance operations related to the ORR Call Center and execution of project deliverables. The position will in coordination with operations manager new performance strategies to ensure compliance as w ...

  • Lucifer Lighting

    Quality Assurance Manager

    2 weeks ago

    Lucifer Lighting San Antonio, United States

    Job Details · Level · Management · Job Location · Corporate Office - San Antonio, TX · Position Type · Full Time · Education Level · 4 Year Degree · Job Shift · Day · Description · Position Summary: · The Quality Assurance Manager is responsible for setting best-in-cl ...

  • ICF International Inc

    Quality Assurance Manager

    2 days ago

    ICF International Inc San Antonio, United States

    The Quality Assurance Manager will be responsible for oversight of all quality assurance operations related to the ORR Call Center and execution of project deliverables. The position will in coordination with operations manager new performance strategies to ensure compliance as w ...

  • ICF International Inc

    Quality Assurance Manager

    4 days ago

    ICF International Inc San Antonio, United States

    The Quality Assurance Manager will be responsible for oversight of all quality assurance operations related to the ORR Call Center and execution of project deliverables. The position will in coordination with operations manager new performance strategies to ensure compliance as w ...

  • BrightSpring Health Services

    quality assurance manager

    3 weeks ago

    BrightSpring Health Services San Antonio, United States

    · QUALITY ASSURANCE MANAGER · Job Locations · US-TX-SAN ANTONIO · ID · Line of Business · ResCare Community Living · Position Type · Full-Time · Pay Min · USD $43,000.00/Yr. · Pay Max · USD $43,000.00/Yr. · Our Company · ResCare Community Living · Overview · The Quality Assuran ...

  • BrightSpring Health Services

    quality assurance manager

    1 week ago

    BrightSpring Health Services San Antonio, United States

    Our Company · ResCare Community Living · Overview · The Quality Assurance Manager (QAM) position is focused on maintaining local compliance with State, Federal and BrightSpring Health requirements. The QAM provides leadership oversight to operations in meeting their goals and ...

  • All Ways Caring HomeCare

    quality assurance manager

    3 weeks ago

    All Ways Caring HomeCare San Antonio, United States

    · QUALITY ASSURANCE MANAGER · Job Locations · US-TX-SAN ANTONIO · Requisition ID · Line of Business: · ResCare Community Living · Pay Min · USD $43,000.00/Yr. · Pay Max · USD $43,000.00/Yr. · Our Company · ResCare Community Living · Overview · The Quality Assurance Manager (QAM ...

  • ResCare

    Quality Assurance Manager

    1 week ago

    ResCare San Antonio, United States

    Our Company · ResCare Community Living · Overview · The Quality Assurance Manager (QAM) position is focused on maintaining local compliance with State, Federal and BrightSpring Health requirements. The QAM provides leadership oversight to operations in meeting their goals and ...

  • Worldwide Clinical Trials

    Manager, Quality Assurance

    3 weeks ago

    Worldwide Clinical Trials San Antonio, United States

    Who we are · We're a global, midsize CRO that pushes boundaries, innovates, and invents because the path to a cure for the world's most persistent diseases is not paved by those who play it safe. It is built by those who take pioneering, creative approaches and implement them wi ...

  • Optum

    RN Quality Manager

    3 weeks ago

    Optum San Antonio, United States

    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 s ...