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Hours Full-time, Part-time
Location New York, NY
New York, New York

About this job

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)


 



We have an exciting opportunity for a Director, Quality Management and Regulatory Adherence to join our growing team. The role will lead the Quality Management and Regulatory Adherence department to achieve zero defects in our Medicare plans to meet state and federal requirements and zero defects for internal and CMS audits. This leader is also responsible for the program and the day to day oversight of the program. This includes proactive development, evaluation and continuous quality improvement (CQI) for audit readiness, action plan oversight for findings and corrective action plans, policies, CCIPs, QIPS, MOC, SNP requirements technical writing and submissions. This role is responsible for all PBP and H-Contract requirements and submissions across Medicare for UHC.



 


Responsibilities:


 



  • Leads Quality Management and Regulatory Adherence department to achieve zero defects across our Medicare plans for CMS and internal audits based on state and federal regulatory requirements.

  • These requirements include Model of Care, CCIPs, QIPs, Special Needs Plans, and all federal requirements for clinical quality for Medicare Plans.

  • Works with others to develop initiatives in order to meet CMS federal and state requirements and to achieve a continuous state of readiness.

  • Achieve/ exceed established annual goals and objectives in alignment with overall QM & Performance shared service and corporate goals & strategies.

  • Monitor / audit program against goals to assess program success and alignment and to identify opportunities for improvement.

  • Collaborates with internal plan leader and cross functional departments to identify gaps and drive to closure.

  • Forms internal and external strategic relationships which will support program innovation, improvement, and a continuous state of readiness.

  • Continual refinement of the quality program structure and processes to promote system-wide regulatory compliance as well as continuous assessment and improvement.

  • Interaction with regulatory agencies and cross departmental functional areas

  • Monitors and reports on status and raises concerns regarding project issues, risks and deadlines

  • Check for gaps or risks identified in responses and contact the appropriate parties to coordinate State needs/requirements.

  • Responsible for continuous quality improvement process in this domain..

  • Fosters innovative problem solving and upholds principles of continuous quality improvement (CQI).

  • Works in collaboration with others to provide updates, evaluations, and training as well as identification for opportunities for improvement.& strategies.

  • Other duties as assigned

Requirements

Requirements:




  • BA/BS degree in healthcare related or business related field. Advanced degree strongly preferred.

  • 3+ years working in Medicare preferred.

  • 3+ years' experience and knowledge of quality, quality improvement, managed care, process and audit readiness required.

  • Ability to work with individuals across departments and at all levels of management

  • Ability to work under tight deadlines and manage multiple projects simultaneously

  • Ability to review documents for quality, voice, spelling, consistent and correct grammar.

  • Clear, concise written and verbal communication, rapid rapport building, and attention to detail are required.

  • Must be highly organized, detail-oriented, proactive, resourceful, and able to exercise sound judgment.

  • Strong computer skills including MS Word, MS Access, PowerPoint SharePoint, Microsoft Project, and Outlook with excellent skills in MS Excel required




 


 


Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 14 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, 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.




UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.


 


 



Keywords: Quality, Medicare, Managed Care, Leadership, Telecommute.