The Quality Management Manager will monitor and support the health plan quality improvement initiatives with particular emphasis on HEDIS, NCQA, and State Performance measures. You'll act as a voice for our members, guiding the development of comprehensive care plans that will help others live healthier lives.
You'll enjoy the flexibility to work remotely * if you are located in Pennsylvania as you take on some tough challenges. This position is remote with up to 10% travel within the PA market.
Primary Responsibilities:- Oversee the implementation of plan's quality improvement program (QAPI)
- Work to coordinate the work with the clinical, operations, and network teams to improve HEDIS and NCQA performance and to close gaps in care
- Manage Quality work plan programs and activities
- Collaborate across local and national business segments to achieve goals and targets
- Develop and maintain positive relationships with external state organizations within the scope of Quality Management
- Continuously monitor HEDIS, NCQA, and state performance measure results and adjust programs to ensure targeted goals
- Support Performance Improvement Projects, accreditation, and regulatory audits as needed
- Develop and mentor quality department staff
- Oversee quality quarterly review meetings with state partners
- Serve as panelist for grievance and appeal hearings
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:- RN License in the state of Pennsylvania
- 2+ years of experience with HEDIS and NCQA - this includes PIP and quality improvement project experience
- 1+ years of leadership/management experience (e.g., Review work of others, serve as an expert in their field, serve as a mentor and leader, lead functional or segment teams or projects, motivate and inspire team members)
- Experience with outside audit organizations such as External Quality Review Organizations (EQROs)
- Experience with managed care and insurance industry
- Experience in writing reports and analyzing performance data
- Experience creating detailed reports and project management
- Reside in PA
Preferred Qualifications:- 2+ years demonstrated Management experience with responsibility for team performance management
- Quality improvement experience within a health plan- CPHQ Certification
- Experience with excel (working with pivot tables) and creating PPT presentations
- Medicaid experience
- Clinical experience / background
- Change management experience and demonstrated skills
- Proven ability to make independent decisions
- Proven ability to complete various deliverables utilizing scholarly writing and AI technology
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $91,700 - $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable.
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.
