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Quality Improvement Manager - Telecommute in Oahu, HI

UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work. (sm)

The Quality Improvement Program Manager will work closely with the Health Plan Quality Leadership to coordinate quality compliance activities and ensure that we are meeting the organizational, state, NCQA, CMS and other requirements as applicable. This position will serve as a liaison between departments within the health plan and remainder of the organization to coordinate an interdisciplinary approach to improve member outcomes and provider performance. Primarily responsible for the development and/or on - going management and administration of clinical quality programs, audit preparations and development / management of performance improvement projects. Provides implementation support, measurement standards, and revisions as needed that incorporate applicable best practices with proven outcomes. The Position reports to the VP of Quality Management for Health Plan Hawaii.

This role may require travel to support community events, possibly on the weekends. The individual must be comfortable with creating presentations and working with data to formally present information to physicians, administrators, other providers, and community partners.

This is a work from home / telecommute position within Oahu, Hawaii. Travel will be required to the Honolulu office for meetings, offsite Quality Committee meetings, and State sponsored meetings.

If you are located in Oahu, HI, you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

  • Manages all quality committees under the UnitedHealthcare Community Plan umbrella to assure that QM Committee activities are fulfilled, on track and recorded
  • Serves as a liaison with national quality committees to communicate back information to the local plan as needed
  • Assures that quality management documents such as the Quality Improvement Program Description, Quality Improvement Work Plan and the Quality Improvement Program Evaluation are completed, presented for approval, and submitted timely
  • Evaluations are written and updated as required to fulfill requirements of UHC national QMP, NCQA and State regulations
  • Manages all existing QMP policy & procedures, writes new QMP policy & procedures, and matches policy and procedure to regulatory requirement and accreditation crosswalk, and ongoing regulatory and accreditation readiness
  • Provide project management oversight for all activities associated with HEDIS, CAHPS, PIPs, and other projects as assigned
  • Conducts performance improvement projects and complete submission of necessary reports
  • Serves as the QMP manager for quality related audits (i.e. EQRO, HEDIS, etc.) and assures that all QMP requirements under the audit are met
  • Manages quality related reports as required by State, NCQA, etc.
  • Prepare effectiveness studies on program activities to identify improved outcomes and status of meeting set objectives

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:

  • Undergraduate degree in healthcare or business or equivalent experience
  • 1+ years of experience analyzing data and reporting out
  • 1+ years of work experience with writing reports, policy, and procedure
  • 1+ years of Medicare / Medicaid regulations
  • 1+ years in health plan or health administration field
  • Intermediate knowledge of Microsoft Office Suite
  • If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders

Preferred Qualifications:

  • 1+ year of experience with NCQA related activities, EQRO or other health plan accrediting or auditing entity
  • Experience with quality management data measurement systems
  • Experience in designing improvement activities to close gaps in care and documenting performance improvement projects

Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.(sm)

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

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.

Job Keywords: Quality Improvement Manager, Data, Reporting, Medicare, Medicaid, Health Plan, Health Administration, Analyzing Data, Reporting, Writing Reports, Policy, Procedures, Health Plan, Health Administrative, HEDIS, CAHPS, Pips, NCQA, Telecommute, Telecommuting, Telecommuter, Work From Home, Work At Home, Remote, WAH, Oahu, HI

Quality Improvement Manager - Telecommute in Oahu, HI

United Health Group
Full Time

Published on 11/24/2021

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