Member Outreach Supervisor - Newark, NJ

There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Nursing here isn't for everybody. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Ready for a new path? Start doing your life's best work.(sm)
 
The Clinical Quality Supervisor is responsible for providing direction and guidance to a team on clinical quality improvement programs that support accreditation. The focus is to develop and plan programs to improve member quality of care and increase HEDIS quality scores. The supervisor is self-directed and serves as a resource to the team on complex member issues and promotes preventive care through outreach and education via live telephone calls, written materials, community service programs and data collection.
 
This position reports to the Senior Director Clinical Quality and is part the Quality Management Department supporting the New Jersey Community and State Health Plan.
 
Primary Responsibilities:

Design, create and implement Quality Improvement projects and initiatives to close gaps in care through member live calls and face-to-face community outreach and education
Support medical records collection to supplement HEDIS clinical outcomes
Identify Quality improvement or intervention opportunities and work cross-functionally to develop interventions or recommendations to close gaps in care
Develop outreach call scripts, education materials and written communication for member education and manage approval process through the state and regulatory agencies
Collect, analyze and interpret data or information (e.g., clinical, administrative, Quality) to ensure they meet standards, are compliant and / or are accurate and complete
Analyze monthly data from MedMeasures to identify gaps in care
Provide analytical support and expertise when compiling and reporting information
Assist in developing department strategic action plans including identification of objectives, goals and strategies
Lead, coach and/or mentor associates; track individual production and quality outcomes
Document and Report Quality Information:

Develop or update work plans, update program descriptions and program evaluation
Review results, conduct analyses (e.g., evaluate against goals / effectiveness of interventions over time), and prepare reports on findings
Utilize computer systems to identify and annotate information
Develop an understanding of the intended audience and determine the best method to communicate data or information
Communicate Quality data or information in writing or verbally
Perform / Participate in Audits or Review Activities to Ensure Quality:

Review relevant agreements (e.g., contractual, intersegment) and obtain clarification as necessary
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
Develop and / or assist with corrective action plans based on audit findings or customer feedback
Review processes and performance against customer expectations to provide needed information or service
Manage Quality Projects or Work Objectives:

Identify and recruit appropriate staff and coordinate / set appropriate deadlines when necessary
Provide information and feedback to project team with respect to achievement of objectives
Leverage clinical expertise to inform decision-making and program development
Track timeframes / deadlines and collect data or information within required timeframes
Identify, prioritize, and proactively communicate potential barriers or risks to key stakeholders
Provide Quality Information, Education or Training to Others:

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
Communicate and explain applicable standards (e.g., industry/performance) and / or technical specifications and identified gaps and / or changes in applicable standards
Develop educational materials (e.g., member, provider and / or staff materials)
Work with others to ensure messaging to members and / or providers is appropriate to the audience, complete / accurate, and compliant (e.g., with external / internal regulations and protocols)
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)
 

Required Qualifications:

Bachelor’s degree
2+ years of call center experience
2+ years of managerial experience
Intermediate computer skills with the ability to navigate a Windows environment. Create, edit, save and send documents utilizing Microsoft Word
Ability to navigate Microsoft Access databases
Preferred Qualifications:

Previous healthcare and / or HEDIS experience
Prior experience  working with the Medicaid and/or Medicare population
Bilingual Spanish 
Demonstrated ability to manage multiple projects simultaneously
Ability to collect, analyze and present data
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: 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.
 
 
Job Keywords:  Manager, Supervisor, Member Outreach, Call Center, Health Care, Medicaid, Medicare, HEDIS, STARS, Medicaid, Medicare, Managed Care, Bilingual, Spanish, Newark, Edison, NJ, New Jersey, UHC, UnitedHealthcare, Community and State, Public Sector, UHG