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Sr. Director Quality - Payment Integrity - Telecommute

UnitedHealth Group


Location:
Eden Prairie, MN
Date:
09/05/2017
2017-09-052017-10-04
Job Code:
1782231
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Job Details


Sr. Director Quality - Payment Integrity - Telecommute(Job Number:728845)
Description

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)



Primary Responsibilities:

  • Leads the Optum Payment Integrity Operations, Quality Control organizations. Responsible for the staff performance and development of the quality control programs, including:

    • Ensuring adequate and ongoing sampling methodologies

    • Measuring outcomes against customer expectations, compliance, and business level key performance drivers

    • Implementing standardized quality control reporting and dashboards

    • Identifying and communicating top quality defects and risks, as well as facilitating and monitoring remediation efforts

    • Developing and demonstrating an understanding of upstream and downstream impacts and risks to E2E business processes and work with business partners to implement solutions

    • Demonstrating an understanding of relevant organizations’ operations, products and applications, strategies, processes, and/or business priorities in order to build effective solutions

    • Effectively communicate and implement the quality strategy and vision (TQM Roadmap) within the quality organization

  • Assess and identify operational quality gaps and priorities, synthesize complex issues and succinctly recommend actions/improvements and build detailed plans for execution

  • Scope and design end-to-end solutions based upon root cause identification

  • Demonstrates an understanding of the components of a Total Quality Management (TQM) system and works with supported matrix partners to communicate, develop, implement, and manage to those components as noted below:

    • Voice of the customer; Understanding client, provider, and member quality expectations and Net Promoter Score drivers and translating those into actionable measures

    • Business Process Documentation Management. Key Process have been identified and documented and are available for use, up to date, and appropriately controlled

    • Customer Requirement Metrics (Scorecard). Monitoring of Customer Scorecard with the level of detail and frequency required to meet or exceed customer requirements and associated process changes documented as required

    • Key Process Performance & Monitoring Control. All key processes being monitored, managed, and analyzed with consideration of customer and process requirements and desired outcomes using standard metrics and controls

    • Accreditation & Compliance. Where applicable, dedicated accreditation and compliance functions insuring standards of quality are maintained based on customer needs and regulatory and legislative requirements

    • Quality Control. Ongoing inspection of process and sampling of outcomes for compliance to a standard, a customer expectation, or an internal requirement

    • Continuous Improvement. Formal methodology to monitor operational performance and voice (consumer, employee, provider, process) analytics to identify, prioritize, and execute continuous improvements with dedicated resources focused on operational excellence

    • Issues Management. A process and tool established enabling employees to enter Customer quality issues, formal complains, and escalations resulting in prioritized resolution and tracking

    • Quality and Process Training. Process owners and/or employees’ manager ensure that personnel performing work affecting conformity to product requirements are competent on the basis of appropriate education, training, skills and experience

    • Total Quality Management System. The leader of the organization puts Quality Management at the same level of as financial management and incorporates Quality Reviews into their ongoing management meetings

    • Large scale change. Manage large scale organizational change to minimize the impact to quality

  • Leverages Six Sigma Lean and process improvement principles, tools, methods and techniques to identify, remediate, and monitor improvement efforts

  • Develops and manages to operational Budgets and Forecasting models


Job Business Process & TQM
Primary Location US-MN-Eden Prairie
Other Location United States
Organization Optum Ops-Claims
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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