Vice President Quality, Medicaid - Full-time / Part-time

This position has national accountability for the C&S Quality Management Regulatory Adherence and Quality Improvement programs for Medicaid and DSNP and Special Needs Plans products. This includes state and federal requirements, Accreditation, HEDIS, and State specific measures.  The position works closely with members of the C&S Executive Leadership, Regulatory and Compliance, Marketing, Clinical Services, Optum, C&S Operations, and other UHG departments responsible. These programs cover approximately 5.1M members across 25 states.

Primary Responsibilities:

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  Responsible and accountable for  Quality Management and Improvement Program for all Medicaid and DSNP products, based on State, Federal and Customer Requirements


• Build and maintain relationships, to drive accountability and reach goals, with leadership across C&S, this would include M&R Executive Leadership, Regional Leadership, Regulatory and Compliance, Operations, Clinical Services, Optum and key external stakeholders


• Conducts and directs program evaluations and analyses to guide strategic planning for the quality requirements


• Assures that the overall goals, strategies, tactics and resources are aligned with Executive Leadership of C&S, M&R and key stakeholders


• Drive improvements across multiple areas to achieve HEDIS and state goals for Accreditation and State requirements


• Drives reporting and analytic requirements and key performance indicators to assure day to day and weekly performance indicators are monitored toward goals of zero defects in regulatory adherence and 100% gaps in care closure


• Assure changes in state, federal, NCQA or other entities driving quality measures and standards are implemented into the programs and that leaders across UHG are informed and implementing changes as intended


• Aligns and coordinates the work within the QMP Centers of Excellence for:  HEDIS data collection, Data Analytics and Reporting, Accreditation, Member Surveys, Regulatory Adherence, and Member Activation and Engagement.  Utilizing the expertise, standard process, and capabilities of these areas to enhance quality program performance of the plan


• Ensure that QMP anticipates and prepares for the numerous changes that will or would impact our business internally and externally

Required Qualifications:

• Advanced degree


• 7+ years of leadership and managerial experience


• 4+ years' experience with federal and/or state regulatory compliance assessment


• Thorough and deep Medicaid and Medicare business knowledge


• Experience with quality improvement processes and accreditation, including clinical performance measurement

Competencies:

• Presentation skills: Demonstrated ability to build content tailored to audience and present formally (using PPT) to all levels internally and externally 


• Communication skills: Strong ability to write and verbally communicate to the right stakeholders at the right time in an appropriate fashion


• Strong independent decision maker and risk taker


• Advanced level process and project management skills


• Leadership skills: Demonstrates a caring, respectful and compassionate attitude towards all people.  Takes responsibility for personal growth, takes initiative to meet the challenges within the environment, oriented toward solutions through collaboration, able to motivate and lead experienced healthcare professionals, and ability to lead complex projects and optimize the output of teams.

Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to 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.

Job Keywords: managerial, Medicaid, Medicare, compliance assessment, Minnetonka, MN, Minnesota