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 and help people live healthier lives while doing your life's best work.(sm)

Positions in this function are responsible for overseeing and participating in day-to-day management of value-based patients’ overall Star ratings.

This function is responsible for the direct management of the Quality team and indirect management of clinical staff in any number of employed and affiliate clinics. Responsibilities include partnering with and influencing our Provider populations.

General Job Profile

• Accountable business owner for Quality initiatives for our 37K Value Based patients
• Day to day activities include data analysis and operational activities to identify opportunities and drive outcomes to improve HEDIS/Pharmacy initiatives to drive overall Medicare Quality/Star results
  

Primary Responsibilities:

• Owns the end-to-end process to drive Quality for our patients and our organization
• Driving, implementing, and leading Quality strategies to achieve expected outcomes
• Develops functional, market level, and/or site strategy, plans, production and/or organizational priorities including but not limited to:
  • Coordinating and prioritizing HEDIS initiatives between 3 payors and the employed/IPA spaces
  • Partner with local and national clinical pharmacy teams to coordinate and prioritize pharmacy Quality endeavors
  • Coordinating survey efforts to maximize CAHPS/HOS results
  • Partners with OptumCare Regional/National teams for initiatives/results
• Identifies and resolves technical, operational, and organizational problems outside own team
• Product, service, or process decisions are most likely to impact entire functions and/or customer accounts (internal or external)
  

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 Qualification:

• Undergraduate degree or equivalent experience
  

Preferred Qualification:

• Masters degree
  

Functional Competencies

• CLM_Demonstrate Healthcare Industry Knowledge
  • Demonstrate understanding of relevant healthcare plans (e.g., BlueCross/BlueShield; Humana and UHC Medicare Advantage)
  • Demonstrate understanding of managedcare entities (e.g., ACO; PPO; HMO)
  • Demonstrate understanding of relevant clinical practice regulations (e.g., State Board Nursing; Medical/Clinical Practice; Board of Pharmacy; Medical Board of Examiners; CMS)
  • Demonstrate understanding of state, federal, and private healthcare guidelines, regulations, procedures, and products (e.g., Medicare/Medicaid; HIPAA; MIPAA)
  • Demonstrate understanding of clinicalrelated business environment, trends, and issues (e.g., external healthcare systems; market drivers/issues; competitive issues)
  • Demonstrate understanding of local and/or national labor market issues and resource availability
• CLM_Demonstrate Knowledge of Internal Business Operations
  • Demonstrate understanding of internal processes, workflows, policies, and procedures
  • Demonstrate understanding of relevant financial/purchasing procedures and terminology
  • Demonstrate understanding of tools and systems specific to the business segment (e.g., human capital systems/processes)
  • Demonstrate understanding of relevant software applications (e.g., Microsoft Office applications; SharePoint; Electronic Medical Records)
  • Draft, review, approve, and/or implement business continuity plans specific to clinical operations, when necessary
• CLM_Build/Maintain Relationships and Collaborate with Internal and External Customers
  • Develop/implement processes and programs to shape working relationships with internal and/or external customers
  • Work with internal and/or external customers (e.g., business partners; clinical staff; physicians; facilities owners/operators; health plans) to understand and/or resolve issues (e.g., claims resolutions; care delivery issues; enrollment)
  • Gather feedback from internal and/or external customers (e.g., business partners; clinical staff; physicians; facilities owners/operators; health plans) regarding clinical operational performance and effectiveness
  • Provide feedback to internal and/or external customers (e.g., business partners; clinical staff; physicians; facilities owners/operators; health plans) regarding their performance and metrics (e.g., financial performance; quality metrics)
  • Work with internal and/or external customers (e.g., national/regional/local focus groups) to identify, define, and/or implement opportunities to improve clinical programs and performance
  • Meet with internal and/or external business partners regularly (e.g., JOCs; CRMs) to keep them up to date on clinical performance and issues to guide decisionmaking
  • Remain aware of issues and operations of internal and/or external business partners (e.g., health plans; facilities owners/operators)
• CLM_Communicate Clinical/Medical Information to Customers
  • Translate medical/clinical terminology into terms understandable to specific end users (e.g., business partners; patients; senior leaders; technical clinical support personnel)
  • Translate financial information/indicators into terms understandable to healthcare personnel (e.g., physicians; midlevels; nurses) in order to facilitate cost controls
    

Careers at OptumCare. We're on a mission to change the face of health care. As the largest health and wellness business in the US, we help 58 million people navigate the health care system, finance their health care needs and achieve their health and well-being goals. Fortunately, we have a team of the best and brightest minds on the planet to make it happen. Together we're creating the most innovative ideas and comprehensive strategies to help heal the health care system and create a brighter future for us all. Join us and learn why there is no better place to do your life's best work.(sm)

OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare’s support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.

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.