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Associate Director, HouseCalls - Telecommute US

UnitedHealth Group

Baltimore, MD
Job Code:
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Job Details

Associate Director, HouseCalls - Telecommute US(Job Number:697172)

If you want to achieve more in your mission of health care, you have to be really smart about the business of health care.  Challenge yourself, your peers and our industry by shaping what health care looks like and doing your life’s best work. (sm)


CDQI (Clinical Documentation & Quality Improvement) is charged with effectively implementing, monitoring, and executing on clinical documentation and quality programs that promote patient health while improving the provider practice experience with a special focus on Medicare Risk Adjustment and HEDIS.  CDQI processes on a national level and provides support for OptumCare Care Services and Care Delivery.


This position will report into the Director of Market Relations and will be responsible for driving development and implementation of key Medicare Risk Adjustment & Quality initiatives for the OptumCare HouseCalls organization within Care Services. 


The Associate Director will partner with and support the HouseCalls clinical leadership in the development and implementation of CDQI related initiatives such as Risk Adjustment, Quality, CMS 5 Star, ACOs, and other pay for performance based programs specifically related to HouseCalls business.  This includes monitoring & providing transparency to results and assisting in issue resolution/escalation.  Effective facilitation and communication with HouseCalls leadership, CDQI internal teams, and external business partners is imperative. 



Primary Responsibilities:

  • Aggregation, implementation, & support of the following initiatives:

  • Quality Initiatives

    • Best practices for HEDIS/Star programs; processes and coordination

    • Gaps in care
    • Deploy processes for gap closure, i.e. med adherence and high risk medications

  • Medicare Risk Adjustment

    • Best practices for Nurse Practitioner engagement, incentives, and workflow
    • Opportunity identification for documentation process improvement
    • Supplemental embedded clinical model options/opportunities

    • Data management and reporting
  • Collaborating with clinical Center of Excellence for the development of Training & Compliance programs
  • Screening Management

    • Identify screening opportunities based on HouseCalls performance
    • Screening equipment coordination, migration, and deployment
  • Chart Review

    • Opportunity identification related to chart review, coder query and clinical QA
    • Implement and monitor any chart review programs to ensure scalability
    • Track and monitor provider performance, determine process improvement needs
  • Provider Performance

    • Implement provider scorecards for tracking by provider
    • Deploy action plans for underperforming providers



Critical Success Factors:

  • Working in a matrix environment to drive efficiencies through influence
  • Seeks ways to improve job and operational efficiency and makes suggestions as appropriate
  • Takes ownership of the total CDQI process and provides constructive information to minimize problems and increase provider and market satisfaction

  • Partners with HouseCalls leadership teams and Optum management across markets to coordinate execution and implementation

  • Ensure activities are appropriately integrated into the strategic direction, as well as the mission and values of the company

Job General Operations Management
Primary Location US-MD-Baltimore
Other Location US-TX-Dallas, US-CT-Hartford, US-DC-Washington, US-CA-Irvine, US-IL-Chicago
Organization Local Care Delivery Shared Svc
Schedule Full-time
Number of Openings 1
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UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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