Director Clinical Quality - Telecommute

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Optum delivers Intelligence for Health Care. A UnitedHealth Group company, Optum unites the brightest minds to transform organizations and improve health care through information and technology.

Job Description: A director level accountable for achieving assigned targets for Government Programs and Medicare Advantage/Medicaid providers in their assigned Market(s). The Director is responsible for developing and deploying business plans at the market level with a strong focus on managing CMS HEDIS and Stars initiatives and building relationships across Market(s) (provider and medical management community partners) to develop and optimize business opportunities and brand strength. Serving as the local Market expert, work with central function leads to target local strategies that will result in optimal Market(s) effectiveness. Directors rely on a number of individuals outside their direct organization to deliver services in support of their Market(s). This includes central functions (e.g. finance, analytics and administration), Enterprise Services (e.g. Plan Management, Health Care Economics, Clinical, Billing and Enrollment, Claims, Member Services) and other services network management:

-Ensure targets are met or exceeded for assigned Market(s)
-Monitor Market level trends, risk and opportunities to continually evaluate ability to achieve established targets.
-Create provider targets for direct reports and assist in territory management penetration
-Actively participate in the development and execution of site HEDIS and Stars strategic/business plans
-Influence the development and improvement of operations/service processes
-Drive the development and implementation of short and long range plans.
-Continually assess market competitiveness, opportunities and risks
-Recommend, sponsor, lead and participate in Optum enterprise-wide initiatives.
-Drive initiatives to optimize Medicare and Medicaid payment and reimbursement strategy and capabilities.
-Manage direct reports (Quality Advocates) and coach them to high standard performance to ensure they are:
 -Targeting local providers who would benefit from STARs training.
 -Reaching out to physicians, medical groups, IPAs and hospitals, and building positive, consultative relationships.
 -Educating providers on how to improve accuracy if their STARS ratings relate to patient quality of care.
 -Training providers on our HEDIS and Stars methods and tools, and working toward their compliance with our programs.
 -Collaborating with doctors, coders, facility staff and a variety of internal and external personnel on a wide scope of HEDIS and Stars education efforts.
 -Deliver Actionable and Accurate Data to Providers
 -Facilitation of Annual Assessment, Early Detection, Ongoing Evaluation, Documentation, Coding & Capture of Chronic Disease


-Build and maintain collaborative relationships with Corporate, Business units within UHG and other Medicare Advantage Plans, Provider relations/Network Development, Marketing and Sales, Clinical Operations, Senior Director leadership in each market