Quality Improvement Lead - Hybrid in Southfield, Michigan - 2292330

Quality Improvement Lead

At UnitedHealthcare, were 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 Quality Improvement (QI) Lead supports our mission to help people live healthier lives by leading population-focused initiatives aimed at improving health outcomes, as measured by HEDIS and other key quality metrics. This role manages new and ongoing projects, implementing members, providers, and system-level interventions to close care gaps.

Working in a highly collaborative environment, the QI Lead partners across functions such as Clinical, Provider Engagement, Member Experience, Compliance, and Pharmacy to drive continuous quality improvement aligned with organizational goals.

If you reside in Michigan, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• Lead and coordinate quality improvement initiatives to enhance health outcomes and meet HEDIS, STARS, and other key performance metrics
• Manage projects aligned with regulatory, accreditation, and business requirements, ensuring compliance and continuous performance improvement
• Develop and implement health education and promotion programs to support member engagement and access to care
• Identify and address barriers to care through data analysis, literature review, stakeholder feedback, and community engagement
• Collaborate across departments (e.g., Clinical, Provider Engagement, Pharmacy) to align interventions with population health goals
• Monitor and report on performance trends; support audits, contractual reporting, and quality-related committees
• Facilitate Performance Improvement Projects (PIPs) and contribute to documentation such as Trilogy Documents, Population Health Plans, and Committee presentations
• Engage with community partners and providers to support care coordination, offer training, and drive provider-level quality improvement
• Serve as a clinical subject matter expert to internal teams, leadership, and external stakeholders
• Support special projects and manage program implementations as assigned

Youll 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:

• Active and unrestricted RN license in the state of Michigan
• 3+ years of experience working on programs for patients/members with complex care needs, including chronic conditions and/or behavioral health conditions
• 3+ years of experience in quality improvement, managed care, or healthcare administration, including work with complex care populations (e.g., chronic or behavioral health conditions)
• Experience engaging with providers and community partners across specialties to support quality initiatives
• Intermediate proficiency in Microsoft Office Suite, like Excel, PowerPoint, Word, and Outlook
• Proven solid project and data management skills, including experience working with multiple databases and analyzing healthcare data
• Proven ability to develop and deliver presentations to internal and external stakeholders using virtual platforms (e.g., Microsoft Teams, WebEx/Zoom)
• Proven skilled in reviewing literature and stakeholder feedback to inform program development and improvement
• Resident of Michigan

Preferred Qualifications:

• Certified Professional in Healthcare Quality (CPHQ)
• Experience in managed care organizations, including oversight of NCQA, HEDIS, and/or STARS measures
• Experience with Medicaid, LTSS and/or D-SNP programs
• Experience leading cross-functional teams and implementing health education or quality improvement programs
• Solid knowledge of HEDIS, NCQA standards, regulatory requirements, and the managed care industry
• Familiarity with Health Information Exchanges (HIEs), Electronic Medical Records (EMRs), and practice management systems
• Proven ability to analyze managed care contracts and apply insights to program development
• Proven solid communication skills with the ability to engage stakeholders at all levels
• Demonstrated adaptability and problem solving skills in fast-paced, matrixed environments

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 $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 everyoneof every race, gender, sexuality, age, location and incomedeserves the opportunity to live their healthiest life. 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.