Job Description

Associate Director of Clinical Quality - UHC Community Plan of Oklahoma

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)

The Director of Clinical Quality provides strategic leadership and direction for the quality improvement and management program(s) as a core service to Community & State Plans. The Director works within highly matrixed relationships to lead and develop the overall quality strategy for the plan, insuring the quality program is proactive, continuously improving, applies to all product and programs within the state, and includes both quality management/regulatory adherence and quality improvement.

Primary Responsibilities:

* Oversees the development and implementation of plan quality program including creating strategic partnerships with internal and external stakeholders to ensure a holistic and comprehensive quality program. Owns the end to end process, strategic thinker
* Works to coordinate the work across HEDIS Operations, Data Analytics and Reporting, Accreditation, Member Surveys, Regulatory Adherence, Member Engagement, Medical Quality Applications, and other matrix partners, utilizing the expertise, standard process, and capabilities of these areas to enhance quality program performance of the plan
* Creates a comprehensive Quality Improvement plan, playbook and quality targets that links to contractual and regulatory obligations, value based contracting and other HP identified initiatives
* Oversees and directs as applicable quality improvement activities and interventions and manages committees related to the quality programs such as the Quality Assurance Performance Improvement Committee
* Manages and owns the implementation of initiatives that support achievement of the Medicaid Agencies Quality Performance Program Measures to receive full financial returns
* Ensures strong HEDIS performance
* Cultivate a strong working relationship across business segments to attain or maintain the Plan's compliance with accreditation standards and contractual requirements as they apply to quality
* Develops and maintains positive relationships with State Agency stakeholders and State External Quality Review Organization within the scope of Quality Management and Improvement. Ownership of State Agency Performance Improvement Projects
* Oversees and ensures the completion, integration, maintenance, approval, and submission of the trilogy document, including but not limited to Quality Program Description, Work Plan, Evaluation, and Program Policies and Procedures
* Provide, through partnership with the Chief Medical Officer, strong leadership for the local quality team and integration with the Oklahoma C&S clinical organization to meet the overall strategic quality goals of the HP

This role is a member of the Health Plan's senior leadership and works closely with Chief Medical Officer, Operations (COO), Finance (CFO), Product leader for Dual Special Needs Plans, Marketing and Communications, Network Leadership, Health Services and Compliance.

Required Qualifications:

* Oklahoma licensed registered nurse, Physician or Physician's Assistant
* 3+ years of experience in leading an integrated and progressive quality organization, within the health care industry
* 3+ years of significant leadership and managerial experience
* 3+ years of experience with demonstrated functional knowledge, process improvement initiatives and organizational behavior

Preferred Qualifications:

* Certified Professional in Healthcare Quality (CPHQ), certified by the National Association for Health Care Quality, or certified in Health Care Quality and Management (CHCQM) by the American Board of Quality Assurance and Utilization Review Providers
* Advanced degree
* Expert knowledge of the managed care/health insurance industry and products and services
* Knowledge of Medicaid and Medicare

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

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.