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Manager Clinical Quality - Phoenix, AZ

UnitedHealth Group

Phoenix, AZ
Job Code:
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Job Details

Manager Clinical Quality - Phoenix, AZ(Job Number:711208)

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 requires an experienced mid-market individual familiar with the general operations of a Medicaid and / or a Medicare plan, and some familiarity with quality management within a Medicaid / Medicare market. This position will be responsible for management of professional staff. The success of the quality program also depends upon teams outside of the department that support critical activities, and the ability to professionally communicate, influence and build relationships with departments and staff outside span of control within a shared services environment is critical to success
In addition to leadership skills, a strong comfort with directing data acquisition is needed. Positions in this function are responsible for direction and guidance on clinical quality improvement and management programs.
This position is responsible for managing quality improvement and quality management programs. This position may be responsible for reporting and analysis of quality performance measures, oversight of audits related to regulatory contractual requirements, development of plans and programs to support continuous quality improvement using HEDIS measures and other tools and creation and submission of annual and quarterly submissions to different state regulators.
This position is located on-site at 1 East Washington Street in Phoenix, AZ
Primary Responsibilities:
  • Team Management:  Manage staff within the quality management department, including employees who conduct provider- and member-focused interventions to meet Medicaid and Medicare quality performance goals
  • Annual Regulatory Reporting:  Responsible for design, implementation and approval of quality improvement programs and work plans, as well as development and approval of annual quality program evaluations
  • Quarterly Regulator Reporting:  Responsible for analysis, creation and delivery of quarterly regulatory reports and for ensuring compliance with all quality management requirements specified by regulator in policy or contract
  • Quality Improvement Design:  Responsible for selection and design of new improvement projects based upon analyses, literature review and other quality reviews to improve member care
  • Quality Improvement Interventions:  Responsible for maintaining or improving performance upon contractual and nationally required quality performance metrics, including HEDIS and customized state measures
  • Audits:  Oversee quality audits to ensure appropriate collection, tracking and reporting upon medical records required for focused quality improvement studies or regulatory audits
  • Management of external contractors:  Oversight of external contractors such as HEDIS contractor if needed
  • Quality Liaison: Serve as a leader in cross-functional meetings to accomplish quality improvement and quality compliance goals, and serve as a liaison for regulators or other community-based organizations as needed
  • Committees and Presentations:  Facilitates health plan quality committees by either participating as appropriate or making formal presentations

Job Quality Management
Primary Location US-AZ-Phoenix
Other Location 
Organization C&S Quality Management
Schedule Full-time
Number of Openings 1
Apply on the Company Site

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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