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Director Clinical Quality - Columbus, OH

UnitedHealth Group

Columbus, OH
Job Code:
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Job Details

Director Clinical Quality - Columbus, OH(Job Number:728678)

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 provides strategic leadership and direction for the quality improvement and management program(s) as a core service to Community & State Plans. The Director works within highly matrixed relationships to lead and develop the overall quality strategy for the plan, insuring the quality program is proactive, continuously improving, applies to all product and programs within the state, and includes both quality management / regulatory adherence and quality improvement. This position provides strategic insight and direction to the plan to align with a changing health care landscape as it applies to quality. The plan director is an active contributor in RFP responses, taking lead on the quality portion. This position develops and maintains strong relationships with state regulators, provides leadership input to expand and support provider engagement, and advocacy at the state level. This position coordinates across multiple functional areas including but not limited to: Clinical, Physician Engagement, Member Experience, Benefit Design/Product, Compliance, Network, Behavioral Services, and Pharmacy as needed to support the quality outcomes.


The Director, Clinical Quality is the primary health plan leader accountable for establishing and implementing an effective quality improvement program essential to meet state, federal and NCQA requirements. Responsibilities include:

Primary Responsibilities:

  • Oversees the development and implementation of plan quality program
  • Works to coordinate the work within the QMP Centers of Excellence for: HEDIS Data Collection, Data Analytics and Reporting, Accreditation, Member Surveys, Regulatory
  • Adherence, and Member Activation and Engagement. Utilizing the expertise, standard process, and capabilities of these areas to enhance quality program performance of the plan
  • Partners to develop Quality Improvement plan playbook and quality targets
  • Oversees and directs as applicable quality improvement activities and interventions to close gaps in care and improve outcomes for identified critical quality measures
  • Ensures strong HEDIS performance
  • Collaborates across business segments to attain or maintain the Plan's compliance with accreditation standards and contractual requirements as they apply to quality
  • Develops and maintains positive relationships with State Agency stakeholders and State External Quality Review Organization within the scope of Quality Management and Improvement
  • Oversees and insures the creation, integration, maintenance, approval, and submission of the trilogy document, including but not limited to Quality Program Description, Work Plan,
  • Evaluation, and Program Policies and Procedures
  • Oversees and insures the creation and submission of reports to meet state contractual requirements including Performance Improvement projects (PIPs)
  • Insures and oversees Health Plan Quality Management / committee structure and integrated quality oversight processes
  • Oversees and directs as applicable process improvement plans and corrective action plans for surveys, accreditations, EQROs, and state audits, within the scope of Quality
  • Management and Improvement
  • Represents and gives input to the RFP process as it applies to quality
  • Interviews, hires, and supervises quality department staff
  • Develops, mentors, and coaches staff

*This position is office based in Columbus, Ohio*

Job Quality Management
Primary Location US-OH-Columbus
Other Location 
Organization C&S Quality Management
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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