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Director Clinical Quality - UHC Community Plan - Wisconsin

UnitedHealth Group

Milwaukee, WI
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Job Details

752970 Director Clinical Quality UHC Community Plan Wisconsin

Director Clinical Quality - UHC Community Plan - Wisconsin (752970)

Position Description

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.


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 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
  • Excellent written and oral communication skills with internal and external partners and employees
  • Excellent relationship building skills
  • Strong team building, collaboration and motivational skills
  • Strong, independent decision maker and risk taker
  • Results-oriented

*This position is office based in Wauwatosa, WI.

Required Qualifications:

  • Undergraduate degree or equivalent experience
  • BS / BA in related field
  • Must be an RN and / or CPHQ certification or obtain one within 6 months of employment
  • 3+ year of experience in an integrated and progressive quality organization, preferably within health care industry
  • 3+ years HEDIS and NCQA  - end to end process experience
  • 3+ years of experience with demonstrated functional knowledge, quality process improvement initiatives and organizational behavior
  • Comprehensive understanding of functional areas and the impact in performance and performance measurement of quality

Preferred Qualifications:

  • Advanced degree
  • Strong influencing and negotiation skills
  • Managed Medicaid, Commercial or Medicare Quality experience
  • Strong change management experience and demonstrated skills
  • Strong process and project management skills
  • Demonstrated staff development skills
  • Expert knowledge of the managed care / health insurance industry, products and services

Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.(sm)


*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.


Job Keywords: Clinical Quality, Wisconsin, Milwaukee, WI, Wauwatosa

Job Details

  • Contest Number752970
  • Job TitleDirector Clinical Quality - UHC Community Plan - Wisconsin
  • Job FamilyMedical and Clinical Operations
  • Business SegmentCommunity and State

Job Location Information

  • Milwaukee, WI
    United States
    North America
  • Other LocationsWauwatosa, WI
    Wauwatosa, WI

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelDirector
  • ShiftDay Job
  • TravelNo
  • Telecommuter PositionYes
  • Overtime StatusExempt

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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