- Provides leadership and support in establishing and directing Quality programs, specifically clinical call center and chart review teams
- Develops and maintains policies and procedures that support the corporate initiatives that meet State, Federal legal requirements and standards
- 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 executive team to execute HEDIS/STAR strategies
- Works with 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
- Participates in various teams, committees and meetings at any level required to maintain business necessity
- Maintains 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 program
- Oversees the HEDIS data submission process
- Leads the coordination and completion of projects with cross-functional teams and senior leaders across clinical functional areas to achieve targeted clinical strategic performance goals
- Oversees clinical workflow mapping and performance monitoring using process improvement methodologies to identify workflow gaps and establish future-state recommendations
- Directs clinical best practice identification and standardization adoption in clinical settings with cross-functional teams and senior leaders
- 15+ years of management-level experience in managed care, medical management programs, including 5+ years of experience at the Director level or above
- 8+ additional years of comparable work experience beyond the required years of experience
- Expertise and 2+ years experience in leading a team responsible for prospective and retrospective HEDIS data abstraction and auditing for non-standard supplemental data for HEDIS submission
- Expertise and 2+ years experience in managing daily operations and providing strategic direction for a clinical call center
- Demonstrate knowledge of the business environment and business requirements (e.g., strategy changes, emerging business needs)
- Knowledge of federal and state laws and NCQA regulations relating to managed care, and all aspects of Medical Management
- Knowledge of fiscal management and human resource management techniques
- Proven ability to establish and maintain effective working relationships with employees, managers, healthcare professionals, physicians and other members of senior administration and the general public
- Proven excellent verbal, written communication, presentation, and facilitation skills
- Ability and willingness to travel as determined by business need
- Health plan, healthcare or clinic operations experience
- Active Unrestricted Registered Nurse license in any state
- Experience working in Medicare or Stars Improvement
- Ability to properly drive and operate a company vehicle
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Vice President, Clinical Operations - Eden Prairie, United States - Optum
Description
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 to start Caring. Connecting. Growing together.
The Senior Vice President, Clinical Operations, is a member of the executive management team, reporting to the Senior Vice President, Quality Performance. This position will provide oversight for the clinical call center teams and clinical chart reviewer team responsible for prospective and retrospective HEDIS data abstraction and auditing for non-standard supplemental data for HEDIS submission to health plans. This position will be responsible for managing daily operations and providing strategic direction, leadership, and oversight performance for the clinical call center and chart reviewer teams. This position is responsible for coordinating with appropriate personnel to meet operational program needs and ensure compliance with state/federal health plan requirements, Medicare guidelines, NCQA and health plan requirements. Additionally, this position will provide 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.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
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.
Years of post-high school education can be substituted/is equivalent to years of experience.
Required Qualifications:
Preferred Qualifications:
Physical & Mental Requirement:
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The salary range for this role is $147,300 to $282,800 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
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: 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.
