Quality Improvement Director - Health Plans - Eden Prairie, MN - Full-time / Part-time

What can YOU do with the right information? At OptumInsight, the possibilities and the impact are limitless. 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. As a Senior Consultant you'll provide consulting services to strengthen and improve health care operations that result in stronger financial returns and a healthier health care system. You'll use your strong strategic and business acumen to work closely with clients to define, develop and document business requirements to ensure needs are captured and critical deliveries are executed. This consulting career gives you the opportunity to travel and share in a mission that inspires. You'll see your ideas come to life and your achievements recognized. You won't find tougher challenges. And you won't find smarter people working together to solve them. Join us and start doing your life's best work.(sm)
Primary Responsibilities:

Provide direction and guidance on clinical quality operations, improvement and management programs including health plan accreditation, HEDIS, and CAHPS
Serve as a subject matter expert for all health plan related quality operations/activities including, but not limited to: o Clincial quality measurement and targeted interventions for improvement (HEDIS, CAHPS, HOS, QRS, PQRS) o HEDIS Technical Specifications o HEDIS Supplemental Data strategies o HEDIS Medical Record Review o HEDIS Compliance Audit (including PSV and MRRV audits) o Health plan accreditation (NCQA/URAC/AAAHC) o Disease management o Care management o Quality of care investigations
Serve as a subject matter expert for URAC/NCQA/AAAHC accreditation standards and certification requirements
Develop project plans/assessments to support URAC/NCQA/AAAHC accreditations and certifications (CM, DM, PCMH, etc.)
Conduct URAC/NCQA/AAAHC accreditation education/training
Conduct HEDIS medical record review and hybrid abstraction training
Support sales efforts by serving as a clincial quality SME as part of client sales presentations and/or developing content to support RFP responses
Conduct root cause analysis and develop targeted interventions designed to improve clinical quality outcomes
Evaluate and/or develop Quality Improvement Projects (QIPs) and/or Performance Improvement Projects (PIPs)
Develop documentation to support compliance with accreditation standards (e.g. program descriptions, work plans, policies and procedures, etc.) 
Develop plans and programs to support continuous quality improvement 
 Support the development of consulting offerings managed by the clinical quality practice group

Required Qualifications:

8+ years experience in health plan quality operations
1+ years f experience with NCQA Accreditation
1+ years of experience with HEDIS®
Ability to travel up to 80%
Preferred Qualifications:

1+ years of experience with Health plan quality director/manager preferred
URAC Accreditation highly HEDIS® Medical Record Review abstraction experience
Registered nurse
 
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world?s large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity 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: Health Plans, WellPoint, BCBS, Anthem, Quality Manager, Quality Director, Eden Prairie, MN, Minnesota