Associate Director Clinical Quality- Phoenix, AZ

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.

UnitedHealthcare Quality Management & Performance is an integrated team serving all UnitedHealthcare businesses, focused on improving the health of our members, enhancing our operational effectiveness, reinforcing brand and reputation for high-quality health plans and helping members lives healthier lives.

Quality Management & Performance combines talented individuals from many areas of quality, including HEDIS, CAHPS and Accreditation. Our goal is extraordinary performance that exceeds the expectations of the constituents, customers and members we serve.

The Associate Director, Clinical Quality reports to the Vice President of Quality, and includes a focus upon Quality Improvement and Quality of Care in the Long Term Care (LTC) and Developmentally Disabled (DDj) populations served by UnitedHealthcare.  Responsibilities are varied, and include: Clinical quality program implementation; performance improvement; monitoring and assessment; HEDIS improvements; quality regulatory compliance; and oversight of quality of care/service issues resolution. Provide management of quality improvement programs related to LTC and DD programs within the state, and management of the team of Clinical Quality RNs that investigate Quality of Care Issues across all Medicaid lines of business and conduct site audits of various providers.  Reporting to the regulator across all Quality of Care and performance improvement functions, and serves as the first point of contact for the regulator, including all Immediate Jeopardy notifications that may require immediate action.

In addition to Quality of Care oversight, this position will work to drive continuous improvement in reducing gaps in care or other state performance measures, as well as author reports to regulators and actively supports RFP responses.  This position develops and maintains strong relationships with state regulators as applicable, and collaborates with multiple functions that may include Clinical, Physician Engagement, Member Experience, Compliance, Network, Behavioral Services, and Pharmacy as needed to drive the  quality management program.  

Responsibilities:

Oversight of the Quality of Care, Critical Incidence, and site audit programs

Ensure compliance with all regulatory requirements for the Long Term Care and Developmentally Disabled programs

Quality Improvement

Gaps in care closure

Relationship Management, Internal and External

Fiscal Management

Employee Engagement and Development

Assistance with supervision of quality functions across other lines of business as needed

Requirements:

Current, unrestricted RN license in the State of Arizona
A minimum of 3 years of experience in Long Term Care
3+ years of managerial experience. 
3+ years of experience with demonstrated functional knowledge of process improvement, quality improvement, and change management.
A minimum of 2 years of demonstrated leadership and team development experience
Knowledge of NCQA and HEDIS

Advanced knowledge of Medicaid & Medicare regulations
Experience auditing Clinical Quality programs
Demonstrated staff development skills.
Strong team building, collaboration and motivational skills.
CPHQ a plus.

Keywords: Quality, Arizona, Registered Nurse, LTC, Long Term Care.

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 17 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.SM

Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability status.




UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.