CDQI Regional Associate Director - Pacific Region - CA - Full-time / Part-time

If you want to achieve more in your mission of health care, you have to be really smart about the business of health care. Challenge yourself, your peers and our industry by shaping what health care looks like and doing your life’s best work.(sm)
 
CDQI (Clinical Documentation & Quality Improvement) is charged with effectively implementing, monitoring, and executing on clinical documentation and quality programs that promote patient health while improving the provider practice experience with a special focus on Medicare Risk Adjustment and HEDIS.  CDQI processes on a national level by providing support in all markets served by OptumCare Delivery.
 
This position will report into the Director of Market Relations and will be responsible for developing relationships and driving implementation of key Medicare Risk Adjustment & Quality initiatives for the Pacific Region of OptumCare Delivery. 
 
The Regional Associate Director is responsible for managing the Market Relations program operations and providing market-focused support and value to the OptumCare Pacific Region care delivery organizations.  This includes monitoring & providing transparency to results and assisting in issue resolution/escalation.  Effective facilitation and communication with leadership, CDQI internal teams, and external business partners is imperative.
 
 
Primary Responsibilities:


Aggregation, implementation, and support of the following initiatives:

Medicare Risk Adjustment


Best practices for Provider engagement, incentives, and workflow

Member engagement and growth

Screening equipment coordination, migration and deployment

Supplemental embedded clinical model options / opportunities

Quality Initiatives:


Best practices for HEDIS / Star programs; tool deployment / coordination

Gaps in care

Training & Compliance programs 
 
Critical Success Factors:


Working in a matrix environment to drive efficiencies through influence

Seeks ways to improve job and operational efficiency and makes suggestions as appropriate

Takes ownership of the total CDQI process and provides constructive information to minimize problems and increase provider and market satisfaction

Partners with Care Delivery leadership teams and Optum management across markets to coordinate execution and implementation

Ensure activities are appropriately integrated into the strategic direction, as well as the mission and values of the company

Required Qualifications:


Bachelor’s degree or equivalent experience

3+ years of experience in Medicare risk adjustment

5+ years of combined experience within managed care / health insurance industry experience in government relations, network management, and / or legal / compliance

5+ years of experience in Program Management

5+ years of data analysis, process documentation, and process improvement experience

5+ years of experience interacting with business leadership

50% travel 
Preferred Qualifications:


Strong familiarity with government pay for performance programs and / or consulting background

Previous client facing role experience in program delivery / program management

Experience in Quality with a working knowledge of Star / HEIDS

Strong knowledge of CMS Risk Adjustment and ICD-10 coding requirements and regulations

Lead a complex or multifunctional / multi-location team / organization

Six Sigma certification and / or exposure

Proven experience managing organizational growth and change

Well-honed communication & presentation skills (written & verbal)

Strong execution and accountability across multiple projects and programs; independent delivery

Desire and ability to build strong relationships across a variety of stakeholders

Demonstrate visionary thinking and emotional intelligence

Proficiency with Microsoft Office

 
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system 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: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and 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.