Clinical Quality Manager - Remote in Pennsylvania
UnitedHealthcare · Fort Washington, PA · 1 wk ago
Quality Assurance$92k–$164k/yrFull-time
Primary Responsibilities
- Oversee the implementation of plan's quality improvement program (QAPI)
- Work to coordinate the work with the clinical, operations, and network teams to improve HEDIS and NCQA performance and to close gaps in care
- Manage Quality work plan programs and activities
- Collaborate across local and national business segments to achieve goals and targets
- Develop and maintain positive relationships with external state organizations within the scope of Quality Management
- Continuously monitor HEDIS, NCQA, and state performance measure results and adjust programs to ensure targeted goals
- Support Performance Improvement Projects, accreditation, and regulatory audits as needed
- Develop and mentor quality department staff
- Oversee quality quarterly review meetings with state partners
- Serve as panelist for grievance and appeal hearings
Required Qualifications
- RN License in the state of Pennsylvania AND/OR Master's degree in a Healthcare Field (e.g. Public Health, Health Administration, Health Education, etc.)
- Experience with HEDIS and NCQA - quality improvement project experience
- Experience managing staff or staff mgmt. for projects
- Experience writing reports and managed care industry
- Experience with outside audit organizations such as External Quality Review Organizations (EQROs)
- Reside in the state of Pennsylvania and ability to travel up to 10% in the PA market
Preferred Qualifications
- 2+ years demonstrated Management experience with responsibility for team performance management
- Quality improvement experience within a health plan
- Experience with excel (working with pivot tables) and creating PPT presentations
- Medicaid experience
- Clinical experience/background
- Ability to make independent decisions
- Change management experience and demonstrated skills
- Experience with outside audit organizations such as External Quality Review Organizations (EQROs)
- Experience in writing reports and analyzing performance data
- Experience creating detailed reports and project management