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Associate Director, QIO - WY

UnitedHealth Group

Cheyenne, WY
Job Code:
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Job Details

Associate Director, QIO - WY(Job Number:723318)

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)

This position works with WyHealth Medicaid WY program and is responsible for quality metrics of the program.  This position is a key stakeholder in the success of the overall program and is considered a part of the leadership team in Wyoming.   The Quality Manager Lead achieves success  by ensuring all functions of the WY State WyHealth program are performed in the essence and structure of a QIO-Like entity.  This position will report daily to the local WY office. Candidates must reside in the state of Wyoming.

Primary Responsibilities:

Collect, Analyze, and Investigate Quality Data and/or Information:

  • Collect Quality data and / or information based on applicable standards, state / federal or other regulations, customer or consumer requests, internal requests, or project assignments

  • Identify appropriate sources for data or information either internally or externally and collect data / information

  • Develop effective methods for data/information collection

  • Identify appropriate data platform or application (e.g., data bases, Intranet source, Internet source) and utilize to collect data or information

  • Investigate Quality problems identified and collect additional information to close gaps

  • Work cross functionally and coordinate with others internally or externally to gather information; overcome challenges to obtaining needed information

  • Mine data and / or information to identify inconsistencies, trends, other information needed, etc. (e.g., develop and/or run data queries)

  • Analyze and interpret data or information (e.g., clinical, administrative, Quality) to ensure they meet standards, are compliant and / or are accurate and complete

  • Provide explanations or updates when data / information (e.g., clinical, administrative) are not accurate or unclear

  • Explain the characteristics of the data / information (e.g., clinical, administrative) including any unique attributes

  • Identify Quality improvement or intervention opportunities and work cross - functionally to develop interventions or recommendations.

Document and Report Quality Information:

  • Develop or update work plans (e.g., annual work plan)

  • Develop or update program descriptions (e.g., annual program descriptions)

  • Develop program evaluations (e.g., annual program evaluation)

  • Develop, update, and/or review policies and procedures

  • Review results, conduct analyses (e.g., evaluate against goals / effectiveness of interventions over time), and prepare reports on findings

  • Follow regulations and internal or external protocols for communicating information or data

  • Utilize computer systems to identify and annotate information

  • Load completed information into relevant systems according to specifications

  • Develop an understanding of the intended audience and determine the best method to communicate data or information

  • Communicate Quality data or information in writing or verbally

  • Report results (e.g., quality improvement initiatives, audits) to committees, Board of Directors, external stakeholders, regulatory agencies, etc. and respond to questions or solicit feedback and input

Perform / Participate in Audits or Review Activities to Ensure Quality:

  • Develop understanding of customer requirements and / or expectations and anticipate needs to determine appropriate course of action

  • Develop audit or review processes (e.g., automated / technically driven)

  • Review relevant agreements (e.g., contractual, intersegment) and obtain clarification as necessary

  • Read and interpret standards / requirements and/or technical specifications (e.g., structure and process, CMS star ratings , URAC, NCQA / HEDIS / CAHPS / member satisfaction specifications, SNP)

  • Evaluate current processes, compare to relevant standards or specifications and identify gaps in compliance or performance

  • Perform / participate in assessments of the audit or review (e.g., interrater reliability of audit findings across auditors)

  • Work cross - functionally, making recommendations or clarifying information to assist in closing gaps that are identified or meeting customer expectations

  • Work with auditors or key stakeholders for review / approval of results

  • Develop and / or assist with corrective action plans based on audit findings or customer feedback

  • Review processes and performance against customer expectations to provide needed information or service

Manage Quality Projects or Work Objectives:

  • Define project scope and develop project plan

  • Identify and recruit appropriate staff to assist with projects as necessary

  • Coordinate with others to set appropriate deadlines when necessary

  • Collaborate with stakeholders for review, input, and / or approval at key milestones

  • Manage key relationships (e.g., vendors, stakeholders, regulatory bodies) to ensure milestones are achieved and performance objectives are met

  • Manage or actively participate in meetings (e.g., schedule, present, document meeting results, facilitate)

  • Provide information and feedback to project team with respect to achievement of objectives

  • Leverage clinical expertise to inform decision - making and program development

  • Track timeframes / deadlines and collect data or information within required timeframes

  • Identify, prioritize, and proactively communicate potential barriers or risks to key stakeholders

Provide Quality Information, Education or Training to Others:

  • Educate, motivate, and / or influence others (e.g., leadership, other stakeholders, including those for whom there is no direct line of authority) to understand the overall scope, overcome potential barriers, and engage in and commit to the process

  • Communicate and explain applicable standards (e.g., industry/performance) and /or technical specifications and identified gaps and / or changes in applicable standards

  • Develop educational materials (e.g., member, provider and / or staff materials)

  • Work with others to ensure messaging to members and / or providers is appropriate to the audience, complete / accurate, and compliant (e.g., with external / internal regulations and protocols)

  • Train others on relevant policies, rules, or regulations (e.g., appropriate release of data, handling protected health information)

  • Serve as a resource providing explanations and expertise (e.g., accreditation, providing information to others

  • Serve as a key member of WY Wyhealth Leadership team and active member of the Optum Executive Quality, QIO - Like Committee, and serves as the key point person for the WDH in quality performance issues with the program

Job Quality Management
Primary Location US-WY-Cheyenne
Other Location 
Organization Population Health Solutions
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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