Director of Clinical Quality – Remote

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.

The Director of E&I Clinical Quality has end to end accountability for 45+member engagement programs and overseeing improvement efforts with our National/Special Account partners. It includes deploying member engagement activities and improving member communication channels for over 24M E&I members. This individual works closely with multiple matrix partners, including RVPs & MQDs, National Accounts leads, Special Account leads, Marketing, HEDIS, CAHPS, and Accreditation leaders to determine the most effective strategies for improvement. The individual is accountable in supporting efforts to achieve the highest compliance rates & maximize % of our membership having a Health Plan Rating of 3.5 or higher and opting in to developed programs, they will regularly conduct market & regional strategy meetings to determine best practices, analyzes program effectiveness, monitors vendor performance and propose the most appropriate solution to our business partners. Programs educate and encourage members to work with their provider to close HEDIS gaps in care. The person in this role is expected to work directly with matrix partners to build relationships across the plan and enterprise. The individual must be comfortable with creating presentations and working with data to formally present information.

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• This role will support the UHC E&I Quality book of business and associated teams
• End to end accountability for 45+member engagement programs including email, direct mail, SMS, and home test kits for over 24M E&I members in 2023
• The role is critical to maximizing HEDIS rates, supporting Health Plan Ratings, and closing gaps in care
• Create and maintain key relationships with matrix partners 
• Ability to oversee implementation of corrective action plans
• Create, implement, manage, and execute national programs that are requested by our E&I Health Plans
• Lead cross functional team meetings offering guidance, best practices, and solutions
• Become a vendor relationship owner as needed, through your partnership managing programs
• Conduct market & regional strategy meetings to determine the best practices, analyzes program effectiveness, monitors vendor performance and proposes the most appropriate solution to our business partners
• Partners with Clinical Quality Leadership and other health plan leaders to ensure integrated quality oversight processes are in place with contractual requirements, performance guarantees, and NCQA standards
• Convenes work groups as needed to enable appropriate action regarding goals 
• Provides leadership to department personnel as well as to the various quality programs and improvement activities initiated and delivered by the plan
• Oversees the collection of valid and reliable data, facilitates appropriate quantitative and qualitative analysis as needed to identify sound and meaningful corrective action, and monitors for timely intervention via established quality structure
• Recommends performance improvement programs, based upon industry standard, evidence-based best practices
• Support the market team by sharing expertise and serving as a touch point/SME 
• Evaluate and provide feedback to improve performance of provider support personnel, inclusive of clinical and non-clinical personnel 

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:

• Bachelor’s Degree or equivalent experience 
• Licensed Clinician with clinical quality experience 
• 3+ years of demonstrated quality management/quality improvement program experience in a large healthcare corporation 
• 3+ years of management/supervisory experience 
• 2+ years of experience working with HEDIS measures and instituting appropriate interventions 
• 1+ years of experience working with managed care accreditation and/or regulatory requirements 

Preferred Qualifications:

• Master’s Degree 
• Experience with Clinical Engagement Programs
• Advanced knowledge base of Health Plan Ratings, Accreditation Standards, HEDIS, CAHPS, of care, and preventive health, 
• Proficient Microsoft Office skills with exceptional analytical and data representation expertise; Advanced Excel, Outlook, AI, and PowerPoint skills 
• Ability to solve process problems crossing multiple functional areas and business units
• Ability to analyze problems, draw relevant conclusions, and devise and implement an appropriate plan of action

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

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $132,200 to $226,600 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.