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Sr Clinical Program Manager

2 months ago

Wilmington, United States UnitedHealth Group Full time

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

This position provides for management of the organizational quality management program as a core service to Community & State Plans in a highly complex and at-risk environment. The Sr Clinical Program Manager works within highly matrixed relationships to support full implementation of the annual quality management program, inclusive of an annual Quality Management and Improvement Program (QMIP) and a Quality Improvement Work Plan (QIWP) that considers opportunities identified in the prior year program Quality Improvement Evaluation (QIE). The program, and its various operational components, will comply with all state Medicaid and any associated federal regulatory requirements.

This position develops and maintains strong relationships with state regulators as applicable. It further collaborates with staff of multiple departments that may include Clinical, Physician Engagement, Member Experience, Benefit Design/Product, Compliance, Network, Behavioral Services, and Pharmacy as needed to support quality management program initiatives. Lastly, the Sr Clinical Program Manager actively supports the development of content in support of RFP submission, as may be pursued.

If you are located in North Carolina, you'll enjoy the flexibility to work remotely as you take on some tough challenges.

Primary Responsibilities:

  • Partner with Clinical Quality Manager, Director of Quality and other UHC Community Plan of North Carolina health plan leaders to support development and implementation of the annual Health Plan Quality Management Program, inclusive of adequate quality oversight processes and comprehensive quality committee structure
  • Foster and maintain productive and collaborative relationships with cross functional health plan teams
  • Work in collaboration with key stakeholders to develop, implement, and oversee quality improvement initiatives to ensure compliance with early and periodic screening, diagnostic, and treatment (EPSDT) contractual and regulatory standards and enhance the delivery of services to beneficiaries.
  • Act as a subject matter expert regarding NCQA accreditation and state regulatory requirements deemed in scope for Quality
  • Establish an annual reporting calendar which enables proactive organizational work on report production that facilitates ability for internal review no less than three weeks prior to due date and actual submission one week prior to due date.
  • Supports production of assigned QAV/Quality reports to DHB's specifications
    • Take steps to ensure validity of data and/or narrative content prior to submission by engaging appropriate SMEs
    • Escalate when identified issues remain unresolved in a timeframe that enables correction prior to due date
  • Develop quality operational policies and procedures (P&Ps) as needed to ensure uniformity/consistency of operations
  • Monitor the effect of the quality committee structure and revise as needed to acknowledge organizational needs
  • Convey expectations regarding use of tools in establishing uniformity in approach when committee meetings are held, such as presentation of data, indication of action taken/to be taken, and evaluation of effect of action taken, as appropriate
  • Work with Clinical Quality Manager and National contacts to establish and implement accreditation project plan, indicating actions needed at the Element and/or Factor level
  • Direct the engagement and education of various health plan functional areas in producing needed evidence to demonstrate compliance to NCQA, EQRO, and DHB accreditation/audit/oversight requirements deemed in scope for Quality
    • Initiate and assess status of corrective action plans as needed

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

  • 2+ years working with an integrated and progressive quality organization, preferably within health care industry
  • 2+ years demonstrated functional knowledge related to regulatory adherence of a quality management program, NCQA accreditation, EQRO oversight audits, state Medicaid reporting, quality committee management
  • 1+ years of excellent relationship building skills and performance/results driven
  • 1+ years of experience presenting to executives using advanced written and verbal communication skills
  • 1+ years of knowledgeable of the managed care/health insurance industry, products and services
  • Advanced computer skills, knowledge of MS Office products
  • Willing to travel within the state of North Carolina up to 25%

Preferred Qualifications:

  • Certified Professional Healthcare Quality (CPHQ)
  • Knowledge of North Carolina Medicaid
  • Local candidates to the state of North Carolina
  • Solid influencing and negotiation skills with the ability to make independent decisions
  • Solid team building, collaboration and motivational skills

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

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.