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VP Clinical Quality, RN HEDIS/STARS-San Antonio, TX 10k Sign On

UnitedHealth Group

San Antonio, TX
Job Code:
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Job Details

VP Clinical Quality, RN HEDIS/STARS-San Antonio, TX 10k Sign On(Job Number:684782)

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 has responsibilities for Quality Performance Improvement activities for WellMed Medical Management across multiple geographies regarding HEDIS/STAR ratings. Serves on multiple Optum Clinical and Quality Committees and leadership teams designed to provide strategic direction for all local care delivery groups within Optum.

Provides strategic direction, leadership and oversight for enterprise Quality performance.  Responsible for planning, organizing, and directing the administration of all Quality Programs. Provides leadership to and is accountable for the performance and direction through multiple layers of management and senior level professional staff. Responsible for coordinating with appropriate personnel to meet operational program needs, ensures compliance with state/federal health plan requirements, Medicare guidelines, NCQA and health plan requirements. Provides long-term planning and oversight to ensure activities are appropriately integrated into strategic direction and operations, as well as the mission and values of the company.


Primary Responsibilities:

  • Provides leadership and support in establishing and directing the Quality Program for WellMed
  • Develops and maintains policies and procedures that support the corporate initiatives that meet State, Federal legal requirements and standards
  • Collaborates with physicians to execute the implementation of the clinical quality data initiatives as defined by enterprise and/ Optum LCDO
  • Provides expertise to the training department on HEDIS / STAR measures and tools that support collection of and communication about HEDIS / STAR to the enterprise
  • Develops HEDIS / STAR member and provider engagement strategies
  • Collaborates with WellMed executive team to execute HEDIS / STAR strategies
  • Works with Optum LCDO Quality leadership team to provide HEDIS / STAR reporting and to develop strategic direction
  • Facilitates, integrates, and/or coordinates the implementation and evaluation of identified quality improvement / HEDIS / STAR activities as requested by UHG / UHC or related companies
  • Promotes understanding, communication and coordination of all quality improvement program components
  • Participates in requested evaluations and audits for UHC and other health plans
  • Coordinates reporting on quality initiatives to all appropriate committees
  • Assists with the development of the QM and UM Work Plan, Evaluation and the monitoring of Work Plan activities as they relate to clinical Performance Improvement
  • Participates in various teams, committees and meetings at any level required to maintain business necessity
  • Maintains QI program documents, reports, and committee minutes and follows all internal privacy and confidentiality policies and procedures
  • Maintains current knowledge of regulatory requirements associated with the QI program
  • Oversees HEDIS data submission process to all contracted health plans
  • Leads accreditation efforts as defined by enterprise
  • Leads the coordination and completion of projects with cross-functional teams and senior leaders across medical/nursing/clinical functional areas to achieve targeted clinical strategic performance goals
  • Oversees medical / nursing / clinical workflow mapping, performance monitoring, and coaching site visits in clinic settings using process improvement methodologies to identify workflow gaps and establish future-state recommendations
  • Directs medical / nursing / clinical best practice identification and standardization adoption in clinical settings with cross-functional teams and senior leaders
  • Directs and promotes clinical support for clinic staff and nursing roles (RN / LVN Health Coach) with subject matter expertise and resources for population management, nurse advocacy and development opportunities, and nurse coaching / feedback programs

Job Quality Management
Primary Location US-TX-San Antonio
Other Location US-TX-Dallas, US-TX-Houston, US-TX-Austin
Organization WellMed Medical Mgmt, Inc
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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