Job Description

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

The Director of Quality at Optum Idaho develops, implements, manages and continuously improves the Quality program operations and supports the QM program in collaboration with the Quality Manager and Chief Medical Officer.  This person is responsible for overall quality strategy and planning for the full continuum of behavioral health services; including established standards, protocols, organization structure, ad hoc quality audits, committees, and training activities.  The Director of Quality communicates QI requirements, activities and projects to Sr. leadership and Executive Director and ensures required quality improvement standards of the contract are met.  Additional responsibilities include directing Quality team staff in their daily functions and on multi-disciplinary teams to assure adherence to quality standards as well as coordinating and collaborating with the State and other stakeholders in areas related to quality standards and requirements.

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

Primary Responsibilities:

Serve as the clinical leader and Subject Matter Expert (SME) of the Quality Department
Interface and coordinate with departments on matters related to quality improvement within Optum Idaho
Act as the local liaison to the national Quality Auditing Team
Facilitate Optum committee meetings related to quality
Participate in external stakeholder meetings as needed
Ensure Quality Improvement program compliance with national and contract standards, and modify QI policies and protocols as necessary
Oversee the process for addressing quality of service complaints and quality of care (QOC) concerns
Oversee the disputes and appeals process
Participate in and support annual External Quality Review (EQR) activities
Develop clinical quality analytic information to support effectiveness of care management, network performance and care gaps
Report on the status of quality projects for the state and senior management
Manage, coach and develop direct reports
Other duties as assigned by the Deputy Director

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:

Master’s degree in behavioral health or related field
Independent Mental Health License (LPC, LMFT, LCSW, LCPC, etc.)
3+ years of experience working with regulatory and accreditation agencies and their QI requirements, including CMS, HEDIS, URAC and NCQA / Joint Commission
3+ years of supervisory or management level experience
Proficiency with MS Office applications and excellent writing skills
Practiced ability to effectively present information to associates, executive leadership, committees and other stakeholders
Research methodology and statistical analysis skills
Demonstrated success in implementing QI standards and practices across multi-department healthcare settings
Must live within a commutable distance of our Boise, ID office location
Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance

Preferred Qualifications:

Certified Professional in Healthcare Quality (CPHQ) or equivalent evidence of additional training in Quality.
Experience in a managed care organization (MCO)
Experience in quality oversight of clinical position in the healthcare industry, preferably in managed care 
Project management experience in external audit preparation