Manager, Clinical Quality & Value Based Programs
Carreiras no UnitedHealth Group
Estamos criando oportunidades em todas as áreas da assistência à saúde para melhorar vidas enquanto construímos carreiras. No UnitedHelath Group, apoiamos você com as ferramentas mais recentes, treinamento avançado e a força combinada de colegas de trabalho de alto calibre que compartilham sua paixão, sua energia e seu compromisso com a qualidade. Junte-se a nós e comece a fazer o melhor trabalho da sua vida.SM
Carreiras em Tecnologia
No UnitedHealth Group, não estamos apenas usando a tecnologia para ajudar milhões a receber cuidados, estamos evoluindo. Desde as ferramentas e metodologias de desenvolvimento mais avançadas até os mais altos níveis de segurança cibernética, estamos compartilhando e aprendendo novas maneiras de fazer com que a tecnologia e os serviços de saúde funcionem melhor todos os dias. Junte-se a nós e você será desafiado a fazer o melhor trabalho da sua vida.SM
Carreiras Clínicas
Compaixão. É o ponto de partida para profissionais de saúde como você e é o que nos move todos os dias, ao juntarmos nossas habilidades excepcionais com um verdadeiro sentimento de cuidar dos outros. Este é um lugar onde seu impacto vai além de cuidar de um paciente por vez. Porque aqui, todos os dias, você também fornece liderança e contribui de maneiras que podem afetar milhões nos próximos anos. Pronto para um novo caminho? Saiba mais e comece a fazer o melhor trabalho da sua vida.SM
Carreiras em Serviço ao Cliente
Nossas equipes de atendimento ao cliente e ouvidoria estão ajudando pessoas de todo o mundo. Podemos oferecer o melhor de você, ao colocar suas habilidades de escuta, análise e resolução de problemas em um ambiente voltado para ajudar a melhorar vidas e melhorar a assistência médica para milhões. Aqui, você descobrirá uma variedade de caminhos para o crescimento profissional no Atendimento ao Cliente e em toda a economia global. Junte-se a nós e descubra por que esse é o lugar para fazer o melhor trabalho da sua vida.SM
Opportunities with Colonial Healthcare, part of the Optum family of businesses. Join our team and advance your career within a leading primary care and specialty medical practice that prides itself on family-focused, patient-centric care. With over 25 years of experience, offices across Sumter, Columbia, Camden, and Manning, SC, and a commitment to reducing wait times and integrating cutting-edge medical advancements, we offer a supportive environment where you can grow professionally. Our dedication to improving the quality of life for our patients through coordinated care and advanced diagnostic services is unwavering. Be part of a network that values Caring. Connecting. Growing together.
Colonial Healthcare is a growing multi-specialty healthcare organization committed to delivering compassionate and comprehensive care to patients across South Carolina.
The Manager, Clinical Quality & Value Based Programs is responsible for leading and supporting quality initiatives within the medical group, including the ongoing success of the Patient-Centered Medical Home (PCMH) model and value-based care. This role focuses on improving patient outcomes through patient-centered care, coordination of services, and quality improvement initiatives. Reporting to the Vice President of Operations, the Manager will work collaboratively with local and regional leaders, providers, patients, and community partners to ensure high-quality, patient-focused care.
Primary Responsibilities:
· Oversees value-based quality performance improvement programs across Colonial Healthcare (HEDIS/Stars/PCMH/CAHPS/HOS/ACO/MIPS).
· Oversees value based care risk adjustment execution and performance across Colonial Healthcare.
· Oversees outreach strategy and informs the workflows, policies, and procedures that govern outreach to and engagement with patients that are due or overdue for annual visits and gaps-in-care.
· Ensures compliance with and achievement against all full-risk and Pay for Performance (P4P) programs across Medicare, Commercial, and Medicaid lines of business.
· Leads workflow development, data collection, health outcomes reporting, clinical audits, and annual submissions related to PCMH.
· Coordinates continuity of care following hospital discharges and emergency department visits.
· Coordinates high risk patient escalation and patient engagement with PCP to address high TCOC and high risk patient engagement initiatives in collaboration with clinical leadership
· Ensures the timely submission of supplemental data to payors and seeks to automate data flows along with IT and Analytics, where possible.
· Monitors historical and current data trends in quality to make recommendations for continuous improvement.
· Leads a team that remains current on quality programs and measures.
· Ensures compliance with HIPAA, corporate policies, and local, state, and federal regulations.
· Coordinate and complete medical records requests for Colonial Healthcare
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:
- High school diploma or equivalent
- Certified or licensed in medical related field (CMA, LPN, Radiologic Technologist, etc.)
- 5+ years previous supervisory and management experience
- Experience with quality-based care/HEDIS
- Solid knowledge of chronic disease management and population health strategies
- Experience with electronic health records and disease registries
- Excellent communication, leadership, and organizational skills
- Ability to work collaboratively across interdisciplinary teams
- Driver’s License and access to reliable transportation with ability to travel 50% of the time to local clinics
Preferred Qualifications:
- 2+ years managerial experience in a medical group practice setting
- Proven ability to find, recognize, motivate, cultivate, and retain employee talent while creating a fair, accountable work environment
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 $71,200 to $127,200 annually based on full-time employment. We comply with all minimum wage laws as applicable.
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.
Detalhes da Vaga
Número da Requisição 2305153
Segmento de Negócios Optum Care Delivery
Condição Empregatícia Regular
Nível de Emprego Manager
Viagem Yes, 50 % of the Time
Status de hora extra Exempt
Horário de Trabalho Full-time
Turno Day Job
Posição de trabalho à distância No
Vagas Similares:
Trabalhando no UnitedHealth Group
No UnitedHealth Group, você trabalhará ao lado de uma equipe de pessoas apaixonadas pelo que fazem e buscando conquistar os mesmos objetivos. Nossa presença e operações comerciais estão se expandindo em todo o mundo, expondo você a colegas e membros da equipe com experiências e pontos de vista amplamente divergentes.
Nossa Cultura
Saiba como estamos construindo equipes onde cada indivíduo é reconhecido por sua experiência e contribuições únicas.

Trabalhando no UnitedHealth Group
No UnitedHealth Group, você trabalhará ao lado de uma equipe de pessoas apaixonadas pelo que fazem e buscando conquistar os mesmos objetivos. Nossa presença e operações comerciais estão se expandindo em todo o mundo, expondo você a colegas e membros da equipe com experiências e pontos de vista amplamente divergentes.