Manager of Clinical Quality - Tennessee

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)

Primary Responsibilities:

• Oversees the implementation of plan quality management components 


• Works to coordinate the work within the QMP Centers of Excellence for: Accreditation, Member Surveys, and Regulatory Adherence 


• Collaborates across business segments to attain or maintain the Plan's compliance with accreditation standards and contractual requirements as they apply to quality 


• Develops and maintains positive relationships State External Quality Review Organization within the scope of Quality Management


• Insures the creation, integration, maintenance, approval, and submission of the trilogy document, including but not limited to Quality Program Description, Work Plan, Evaluation, and Program Policies and Procedures 


• Insures the creation and submission of reports to meet state contractual requirements including Performance Improvement Projects (PIPs) 


• Insures Health Plan Quality Management /committee structure and integrated quality oversight processes 


• Directs as applicable process improvement plans and corrective action plans for surveys, accreditations, EQROs, and state audits, within the scope of Quality Management 


• Interviews, hires, and supervises quality department staff 


• Develops, mentors, and coaches staff
  

Required Qualifications:

• Bachelor's degree in related field. Advanced degree a plus. 


• 5+ years of experience in managing an integrated and progressive quality or compliance program, preferably within health care industry 


• 5+ years of experience with demonstrated functional knowledge related to regulatory adherence of a quality management program (HEDIS, Accreditation, EQRO, Reporting, Committee Management) 


• Direct staff supervision 


• Must be Relationship Focused, Performance Driven, and Results Oriented 


• Strong written and oral communication skills with internal and external partners and employees

Additional Preferred Assets:

• Demonstrated staff development skills preferred 


• Knowledgeable of the managed care/health insurance industry, products and services 


• CPHQ preferred

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)