Population Health Manager - Remote in New Mexico

Population Health Manager

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.

As a key leader in the clinical operations of the New Mexico health plan, the Population Health Manager will work closely with the Leadership team to coordinate an interdisciplinary approach to care. This will include a focus on health promotion, chronic disease management, behavioral health needs, and social drivers of health (SDoH). Engagement with providers and community resources will be very important. A comprehensive population health assessment inclusive of environmental and historical local drivers of health will inform a metrics and measures based population health improvement plan. In partnership with other members of the clinical team, a component of the role will include provider education and monitoring of quality improvement programs. This includes analysis and review of health outcomes at the provider and aggregated patient-level monitoring, measuring and reporting on key metrics to assist providers in meeting quality and equity standards, state contractual requirements, SDoH initiatives, and pay for performance initiatives. This position will focus on planning and implementing initiatives that are needed and do so in accordance with State, CMS, NCQA, and/or other requirements as applicable.

If you are located in New Mexico, you will have the flexibility to work remotely* in the state, as you take on some tough challenges.

Primary Responsibilities:

• Effective deployment and management of a program at the practice and community levels through strategic partnerships with practitioners, community partners, and internal stakeholders
• Assesses trends in population/quality measures and identifying opportunities for quality improvement
• Designs quality transformation through targeted interventions related to HEDIS/state specific population/quality measures
• Serves as subject matter expert (SME) for population health, preventive health topics, leads efforts with clinical team to research and design educational materials
• Serves as liaison with key vendors supporting population health initiatives
• Consults with vendors and providers to design and implement initiatives to innovate and then improve population health programs measures
• Participates, coordinates, and/or represents the Health Plan at events, state meetings, and other outreach events focused on population health initiatives and disparity programs
• Identifies and addresses population-based member barriers to care and leads the team in identifying local level strategies to overcome barriers and close clinical gaps in care
• Investigates gaps in clinical documentation where system variation has impact on rate calculation, implements corrective plans when issues are verified, and monitors to resolution
• Creates presentations and works with data to formally present information to various stakeholders

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:

• 5+ years clinical or healthcare experience
• 5+ years of healthcare and/or insurance industry experience, including a general knowledge of regulatory and compliance
• 5+ years of experience in a Manager/Director role with adaptable leadership skills with ability to achieve results in a complex organization by aligning goals with employees that are not considered direct reports
• 3+ years of quality improvement/population health experience
• Experience creating presentations and working with data to formally present information to physicians, administrators, state regulator, other providers and community partners
• Experience as a senior level advocate on behalf of the member who can lead a cross departmental team to member resolution
• Proficient experience working with MS Word (create, edit and save documents) and Excel (create, edit and save spreadsheets, formulas)
• Knowledge of population and public health, in both rural and urban settings
• Knowledge of social determinants of health in rural and urban setting in the US Southwest Region
• Proven intermediate software applications skills that include, Microsoft Word, Excel, PowerPoint
• Proven ability to review data and make clinical interventions and consult others
• Dedicated work area established that is separated from other living areas and provides information privacy
• Currently reside in New Mexico
• Willing or ability to travel throughout New Mexico up to 25% of the time

Preferred Qualifications:

• Current unrestricted Registered Nurse (RN) licensure in the state of NM or Licensed Clinical Social Worker (LCSW) OR Population Health Management experience
• Experience creating and executing a strategic plan with measurable outcomes
• Experience working in Medicaid and/or Medicare
• Knowledge of one or more of: clinical standards of care, preventive health standards, HEDIS, NCQA, governing and regulatory agency requirements, Population health approach and the managed care industry
• Understanding and/ or experience working with the Native American and tribal communities
• Background in Managed Care

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). The salary for this role will range from $110,200 to $188,800 annually based on full-time employment. We comply with all minimum wage laws as applicable.