Associate Director of Clinical Quality-Multiple Northeast Locations - Full-time / Part-time

The Associate Director of Clinical Quality will lead the quality strategy and close gaps in care for the assigned State(s). 
 
*We have multiple opportunities available.*
 
Each Associate Director will be responsible for a multi-State territory allowing for full time work at home with minimal travel among the territory and office visits as needed. 
 
Scope of responsibility includes:  Collect, Analyze, and Investigate Quality Data and/or Information, Document and Report Quality Information, Perform / Participate in Audits or Review Activities to Ensure Quality, Manage Quality Projects or Work Objectives and Provide Quality Information, Education or Training to Others.
 
Primary Responsibilities:
 

Collect Quality data and/or information based on applicable standards, state/federal or other regulations, customer or consumer requests, internal requests, or project assignments
Identify appropriate sources for data or information either internally or externally and collect data/information
Report results (e.g., quality improvement initiatives, audits) to committees, Board of Directors, external stakeholders, regulatory agencies, etc. and respond to questions or solicit feedback and input
Read and interpret standards/requirements and/or technical specifications (e.g., structure and process, CMS star ratings,  URAC, NCQA/HEDIS/ CAHPS/member satisfaction specifications, SNP)
Evaluate current processes, compare to relevant standards or specifications and identify gaps in compliance or performance
Perform/participate in assessments of the audit or review (e.g., interrater reliability of audit findings across auditors)
Manage key relationships (e.g., vendors, stakeholders, regulatory bodies) to ensure milestones are achieved and performance objectives are met
Educate, motivate, and/or influence others (e.g., leadership, other stakeholders, including those for whom there is no direct line of authority) to understand the overall scope, overcome potential barriers, and engage in and commit to the process
Train others on relevant policies, rules, or regulations (e.g., appropriate release of data, handling protected health information)
Serve as a resource providing explanations and expertise (e.g., accreditation, providing information to others, satisfaction survey, interventions)

Requirements


5+ years experienced within a managed care organization

5+ years experience with NCQA and/or URAC and/or HEDIS
 
Preferred Requirements


RN with an active, unrestricted license 1 or more of the States for the assigned territory

Certified Professional in Healthcare Quality (CPHQ)

Bachelors degree preferred

3+ years direct staff management
 
 
Careers at UnitedHealthcare Employer & Individual. We all want to make a difference with the work we do. Sometimes we're presented with an opportunity to make a difference on a scale we couldn't imagine. Here, you get that opportunity every day. As a member of one of our elite teams, you'll provide the ideas and solutions that help nearly 25 million customers live healthier lives. You'll help write the next chapter in the history of health care. And you'll find a wealth of open doors and career paths that will take you as far as you want to go. Go further. This is 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, NCQA, URAC, HEDIS, CPHQ, RN, Clinical Operations