Opportunities at WellMed, part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinical staff and non-patient-facing roles, you can make a difference with us as you discover the meaning behind Caring. Connecting. Growing together.
The Quality Manager is responsible for driving consistency in program implementation designed to facilitate a minimum of a 4 Star quality rating. These initiatives should result in contracted network being able to understand and support the vision to change the face of healthcare delivery for seniors. This will drive the financial viability of the market HEDIS/Star program and provide a full quality of care for the members. The responsibilities of this position demand a wide range of capabilities including: strategic planning and analysis skills; solid understanding of HEDIS and coding; management breadth to direct and motivate; highly developed communication skills; and the ability to develop clear action plans and drive process, given often ambiguous issues with numerous interdependencies. This position will facilitate any unresolved issues that remain as a result from following the standard process.

REQUIRED QUALIFICATIONS:

• 5+ years of related experience in Quality/HEDIS/CMS Stars
• 2+ years supervisory (including SME or Team Lead) experience
• Solid working knowledge of Medicare quality operations including HEDIS, Stars, Coding and Medicare Advantage
• Knowledge of state and federal laws relating to Medicare
• Advanced Microsoft Office skills
• Proficient in Excel
• Proven exceptional analytical and data representation expertise
• Ability to travel locally up to 25%
• Driver’s License and access to a reliable transportation

PREFERRED QUALIFICATIONS:

• Project Management experience
• Provider Relations experience
• ICD10/CPT/CPT II coding knowledge
• Solid financial analytical background within Medicare Advantage plans (Risk Adjustment/STARS Calculation models)
  Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $71,200 to $127,200 annually based on full-time employment. We comply with all minimum wage laws as applicable.
  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.
  UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
  UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment

• Manages Quality Coordinators, Clinical Quality Consultants (CQC) I, II and Senior CQC and is responsible for the overall success of the market’s HEDIS/Star results for contracted physicians
• Responsible for all aspects of staff development to include hiring, training, coaching and development
• Maximizes staff performance and technical expertise through clearly defined objectives, training, skill development and leadership to ensure quality services to all customers
• Delegate, monitor and control work progress on key HEDIS/Star metrics, initiatives/action plans, staff productivity, and administrative expenses
• Participates in development and implementation of systems and processes that support quality operations
• Maintains effective cross functional services by working effectively with the Medical Director, Market Medical Director, Market Operations, Regional Team, Clinic Operations and other corporate departments
• Handles complex and/or difficult provider inquires and/or problems and facilitates resolution of provider issues. Continuously strive to ensure that favorable relationships are maintained while ensuring the interest of the organization
• Takes ownership of total work process and provides constructive information to ensure physician partners have support to meet initiatives
• Analyzes data while collaborating and/or participating in discussions with colleagues and business partners to identify potential root cause of issues
• Demonstrate understanding of providers’ goals and strategies in order to facilitate the analysis and resolution of their issues
• Work with relevant internal stakeholders to identify obstacles and barriers identified by providers, and methods for removing them
• Communicate and advocate providers’ needs to internal stakeholders in order to drive creation of solutions that meet our HEDIS/Star goals
• Communicate industry and company information to providers through various means (e.g., newsletters; emails; outreach calls; teleconference; conferences; on-site meetings)
• Develops and coaches staff to facilitate strategic business meetings with physician groups and their staff
• Guides, oversees and ensures competency of the Quality market staff
• Assist corporate and local education team and provides input on tools used to education quality staff and other local provider support staff
• Ensures all education objectives are being met, both on a formal and ad-hoc basis
• Ensuring the quality staff is responding to market operation and provider inquiries
• Facilitates provider discussions and assists in negotiating resolution to escalated provider issues with the capability to determine if/when issues require escalation
• Collectively works with cross functional leadership to eliminate duplication of efforts and member or provider abrasion
• Includes up to 25% local travel
• Performs all other related duties as assigned
  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.