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Director of Clinical Quality - HEDIS and STARS - Full-time / Part-time
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | Atlanta, GA Atlanta, Georgia |
About this job
Optum delivers Intelligence for Health Care. A UnitedHealth Group company, Optum unites the brightest minds to transform organizations and improve health care through information and technology.
Position Description: A director level accountable for achieving assigned targets for Government Programs and Medicare Advantage/Medicaid providers in their assigned Market(s). The Director is responsible for developing and deploying business plans at the market level with a strong focus on managing CMS HEDIS and Stars initiatives and building relationships across Market(s) (provider and medical management community partners) to develop and optimize business opportunities and brand strength. Serving as the local Market expert, work with central function leads to target local strategies that will result in optimal Market(s) effectiveness. Directors rely on a number of individuals outside their direct organization to deliver services in support of their Market(s). This includes central functions (e.g. finance, analytics and administration), Enterprise Services (e.g. Plan Management, Health Care Economics, Clinical, Billing and Enrollment, Claims, Member Services) and other services network management:
Responsibilities for this role:
- Ensure targets are met or exceeded for assigned Market(s)
- Monitor Market level trends, risk and opportunities to continually evaluate ability to achieve established targets.
- Create provider targets for direct reports and assist in territory management penetration
- Actively participate in the development and execution of site HEDIS and Stars strategic/business plans
- Influence the development and improvement of operations/service processes
- Drive the development and implementation of short and long range plans.
- Continually assess market competitiveness, opportunities and risks
- Recommend, sponsor, lead and participate in Optum enterprise-wide initiatives.
- Drive initiatives to optimize Medicare and Medicaid payment and reimbursement strategy and capabilities.
- Build and maintain collaborative relationships with Corporate, Business units within UHG and other Medicare Advantage Plans, Provider relations/Network Development, Marketing and Sales, Clinical Operations, Senior Director leadership in each market
Additionally:
- Targeting local providers who would benefit from STARs training.
- Reaching out to physicians, medical groups, IPAs and hospitals, and building positive, consultative relationships.
- Educating providers on how to improve accuracy if their STARS ratings relate to patient quality of care.
- Training providers on our HEDIS and Stars methods and tools, and working toward their compliance with our programs.
- Collaborating with doctors, coders, facility staff and a variety of internal and external personnel on a wide scope of HEDIS and Stars education efforts.
- Deliver Actionable and Accurate Data to Providers
- Facilitation of Annual Assessment, Early Detection, Ongoing Evaluation, Documentation, Coding & Capture of Chronic Disease
Requirements
Required Qualifications:
- The successful candidate will have a Bachelor's degree in HealthCare, Health Administration, Communications, Science, Business Administration or Finance (or equivalent education and experience).
- Can also have background in consulting, sales, executive coaching (prior pharmaceutical sales ideal)
- 2 or more years of Leadership experience (Manager or Director level) with a proven track record of exemplary leadership experience in the managed health care industry.
- In addition, the chosen candidate must have demonstrated leadership capability in developing new teams, growing existing business and the ability to lead and motivate people; to achieve agreed-upon results.
- 2 or more years of STARS and HEDIS experience required
- Strong technical skills required for Microsoft Word, Excel, PowerPoint, Outlook, Adobe and Access
- Moreover, this individual must have a strong strategic thinking capacity, effective communication skills and a proven track record of building and maintaining multiple effective partnerships.
- Ability to manage and prioritize multiple tasks, promote teamwork and fact based decision
- Ability to influence behavior and assist staff in multiple locations in a highly matrixed organization
Additional Preferred Assets:
- Master's degree
- Demonstrated success, with a deep understanding of Health Care delivery operations and compliance, health care financing an industry trends
- Strong negotiation skills; the ability to gain acceptance from others of a plan or idea and to achieve mutually beneficial outcomes
- Current and unrestricted RN license strongly preferred
OptumInsight is one of the largest and fastest growing health information companies. We specialize in improving the performance of the health system by providing analytics, technology and consulting services that enable better decisions and results. We integrate workflow solutions that deliver data in real-time, and create actionable insights - processing health information that relates directly to and affects one in four patients in the U.S, one in every three Medicaid dollars and one in every five emergency room visits. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance.
What can YOU do with the right information? At OptumInsight, the possibilities and the impact are limitless. No matter what your role is at OptumInsight, you'll be empowered to ask more questions, develop better solutions and help make the health care system greater than ever. It's always fresh. It's always exciting. And it's never been more important.
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.
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