Job Description

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 Senior Clinical Quality Program Manager will work closely with the Health Plan Quality Leadership 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. Provides implementation support, measurement standards, and revisions as needed that incorporate applicable best practices with proven outcomes. This position will focus on tasks that occur in accordance with State of NC, CMS, NCQA or other requirements as applicable. The Position reports to the Supervisor, Clinical Quality.

This role may require travel to locally up to 10% of the time and up to 4 hours away from your residence on occasion. The individual must be comfortable with creating presentations and working with data to formally present information to physicians, administrators, other providers and community partners.

If you are located in the state of NC, you will have the flexibility to telecommute* as you take on some tough challenges. Travel will be required to State sponsored meetings and to the Greensboro or Raleigh office.

Primary Responsibilities:

* Define specific program/process requirements and expectations
* Evaluate workflows, efficiencies, and best practices to determine program/process specifications
* Identify technology needs to support programs/processes and provide or coordinate system and reporting requirements
* Collect and submit data to relevant agencies for accreditation or compliance review
* Use a process driven approach to identify root cause and process improvement opportunities (e.g., DMAIC method, Six Sigma, PDSA, Pareto charts)
* Monitor compliance against relevant process requirements
* Identify opportunities to increase efficiencies or effectiveness and recommended program implementation or process changes
* Use a process driven approach to identify root cause and process improvement opportunities
* Oversee or assist with program or process implementation
* Coordinate with others to develop program or process implementation plans
* Leverage technology to develop and deliver presentations and/or training

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:

* Bachelor's degree in clinically related field or public health or within one year of completion
* 3+ years clinical experience in healthcare and/or insurance industry
* 2+ years of quality improvement experience with responsibilities in the following areas: Model for Improvement and Plan-Do-Study-Act (PDSA) rapid cycle change, data analysis and interpretation, systems analysis, graphical display of data / information, public speaking, group leadership and facilitation, and demonstrated problem solving and critical thinking skills
* Advanced proficient in software applications skills that include, Microsoft Word, Excel, PowerPoint, Visio
* Advanced with creating presentations and working with data
* 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:

* Unrestricted RN licensure in the state of NC
* Experience working in Medicaid and/or Medicare
* CPHQ
* Multilingual candidates
* Graduate degree
* Knowledge of one or more of: clinical standards of care, preventive health standards, HEDIS, NCQA, governing and regulatory agency requirements, and the managed care industry

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, Model For Improvement And Plan-Do-Study-Act, PDSA, Rapid Cycle Change, Data Analysis And Interpretation, Systems Analysis, Graphical Display Of Data / Information, Public Speaking, Group Leadership, Facilitation, Clinical Standards Of Care, Preventive Health Standards, HEDIS, NCQA, Governing And Regulatory Agency Requirements, Managed Care Industry, Senior Clinical Quality Program Manager, Quality, Telecommute, Telecommuting, Telecommuter, Work From Home, Work At Home, Remote, WAH, Greensboro, NC, North Carolina