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Quality Operations Manager Lubbock

Company: UnitedHealth Group
Location: Wichita Falls
Posted on: November 18, 2022

Job Description:

Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life's best work.(sm)
The Quality Manager is responsible for driving consistency in program implementation designed to facilitate a minimum of a 4 Star quality rating. -These initiatives should result in contracted network being able to understand and support the vision to change the face of healthcare delivery for seniors. This will drive the financial viability of the market HEDIS/Star program and provide a full quality of care for the members. The responsibilities of this position demand a wide range of capabilities including: strategic planning and analysis skills; strong understanding of HEDIS and coding; management breadth to direct and motivate; highly developed communication skills; -and the ability to develop clear action plans and drive process, given often ambiguous issues with numerous interdependencies. This position will facilitate any unresolved issues that remain as a result from following the standard process.
Primary Responsibilities:
Manages Quality Coordinators, Clinical Quality Consultants (CQC) I, II and Senior CQC and is responsible for the overall success of the market's HEDIS/Star results for contracted physicians
All -aspects -of -staff -development -to -include -hiring, -training, -coaching -and development
Maximizes staff performance and technical expertise through clearly defined objectives, training, skill development and leadership to ensure quality services to all customers
Delegate, monitor and control work progress on key HEDIS/Star metrics, initiatives/action plans, staff productivity, and administrative expenses
Participates in development and implementation of systems and processes that support quality operations
Maintains effective cross functional services by working effectively with the Medical Director, Market Medical Director, Market Operations, Regional Team, Clinic Operations and other corporate departments
Handles complex and/or difficult provider inquires and/or problems and facilitates resolution of provider issues. Continuously strive to ensure that favorable relationships are maintained while ensuring the interest of the organization
Takes ownership of total work process and provides constructive information to ensure physician partners have support to meet initiatives
Analyzes data while collaborating and/or participating in discussions with colleagues and business partners to identify potential root cause of issues
Demonstrate understanding of providers' goals and strategies in order to facilitate the analysis and resolution of their issues
Work with relevant internal stakeholders to identify obstacles and barriers identified by providers, and methods for removing them
Communicate and advocate providers' needs to internal stakeholders in order to drive creation of solutions that meet our HEDIS/Star goals
Communicate industry and company information to providers through various means (e.g., newsletters; emails; outreach calls; teleconference; conferences; on-site meetings)
Develops and coaches staff to facilitate strategic business meetings with physician groups and their staff
Guides, oversees and ensures competency of the Quality market staff
Assist corporate and local education team and provides input on tools used to education quality staff and other local provider support staff
Ensures all education objectives are being met, both on a formal and ad-hoc basis
Ensuring the quality staff is responding to market operation and provider inquiries
Facilitates provider discussions and assists in negotiating resolution to escalated provider issues with the capability to determine if/when issues require escalation
Collectively works with cross functional leadership to eliminate duplication of efforts and member or provider abrasion
Includes up to 50 - 75% local travel
Performs all other related duties as assigned

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
Bachelor's degree in Nursing, Ancillary Health Care, Health Care Administration, Business Administration, Public Administration, or a related field. -(Associate Degree with an 4+ years of comparable work experience beyond the required years of experience may be substituted in lieu of a bachelor's degree)
5+ years of related experience in Quality/HEDIS/CMS Stars, and ICD10/CPT/CPT II coding knowledge, Provider Relations
2+ years of supervisory experience
Solid working knowledge of Medicare quality operations including HEDIS, Stars, Coding and Medicare Advantage
Knowledge of state and federal laws relating to Medicare
Ability and willingness to travel, both locally and non-locally, as determined by business need
Exceptional analytical and data representation expertise
Advanced Microsoft Office skills. Proficient in Excel
Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation
Preferred Qualifications:
Project Management experience
Solid knowledge base of clinical standards of care, preventative health and STAR measures
Solid financial analytical background within Medicare Advantage plans (Risk Adjustment/STARS Calculation models)
Physical & Mental Requirements:
Ability to lift up to 10 pounds
Ability to sit for extended periods of time
Ability to stand for extended periods of time
Ability to use fine motor skills to operate office equipment and/or machinery
Ability to receive and comprehend instructions verbally and/or in writing
Ability to use logical reasoning for simple and complex problem solving

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.
Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 550,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)
WellMed was founded in 1990 with a vision of being a physician-led company that could change the face of healthcare delivery for seniors. Through the WellMed Care Model, we specialize in helping our patients stay healthy by providing the care they need from doctors who care about them. We partner with multiple Medicare Advantage health plans in Texas and Florida and look forward to continuing growth.

Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Keywords: UnitedHealth Group, Wichita Falls , Quality Operations Manager Lubbock, Executive , Wichita Falls, Texas

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