Quality Improvement Program Manager - Remote on Oahu, HI

Quality Improvement Program 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.

The Quality Improvement Program Manager will work closely with the Health Plan Quality Leadership to coordinate quality improvement and compliance activities and ensure that we are meeting the organizational, state, NCQA, CMS and other requirements as applicable. This position will serve as a liaison between departments within the health plan and remainder of the organization to coordinate an interdisciplinary approach to improve member outcomes and provider performance. Primarily responsible for the development and/or on-going management and administration of clinical quality programs, development/management of performance improvement projects by leveraging data, lead analytical efforts to monitor performance on key quality metrics (e.g., HEDIS, CAHPS, Stars), proactively identify opportunities for improvement, and support cross-functional teams with actionable insights.

This role may require travel to support community events, possibly on the weekends. The individual must be comfortable with creating presentations and working with data to formally present information to physicians, administrators, other providers and community partners.

This is a work from home/telecommute position within Oahu. Travel will be required to the Honolulu office for meetings, offsite Quality Committee meetings, and State sponsored meetings up to 10 percent of the time.

If you reside on Oahu, HI and are able to travel about 10% of the time, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• Develop and implement data-driven strategies to support quality improvement initiatives
• Maintain and enhance reporting systems for HEDIS, Stars, CAHPS, and other regulatory and internal quality metrics
• Conduct data analysis to identify trends, gaps, and opportunities for improvement
• Support quality improvement projects with data analysis, performance tracking, and outcome measurement
• Manages all Quality Committees under the UnitedHealthcare Community Plan Hawaii umbrella to assure that QM Committee activities are fulfilled, on track and recorded
• Serves as a liaison with national Quality Committees to communicate back information to the local plan as needed
• Support with quality management documents such as the Quality Improvement Program Description, Quality Improvement Work Plan and the Quality Improvement Program Evaluation are completed, presented for approval and submitted timely
• Evaluations are written and updated as required to fulfill requirements of UHC national QMP, NCQA and State regulations
• Manages existing QMP policy & procedures, writes new QMP policy & procedures and matches policy and procedure to regulatory requirement and accreditation crosswalk, and ongoing regulatory and accreditation readiness
• Provide project management oversight for all activities associated with HEDIS, CAHPS, PIPs, and other projects as assigned
• Conducts performance improvement projects and complete submission of necessary reports
• Participate in quality related audits (i.e. EQRO, HEDIS, etc.) and assures that all QMP requirements under the audit are met
• Manages quality related reports as required by State, NCQA, etc.
• Prepare effectiveness studies on program activities to identify improved outcomes and status of meeting set objectives
• Other duties as assigned

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:

• 3+ years of experience in the health care field with a focus on healthcare data analysis and quality improvement
• Experience with data visualization platforms (e.g., Tableau, Power BI)
• Experience with MS Word, Excel, PowerPoint, Outlook
• Solid understanding of HEDIS, Stars, CAHPS and other healthcare quality metrics
• Demonstrated excellent communication and project management skills
• Ability to travel about 10% of the time on Oahu, HI

Preferred Qualifications:

• 1+ years of experience with HEDIS, Stars, CAHPS and other healthcare quality metrics
• 1+ years of experience working in health plan or other setting in quality management
• Knowledge of regulatory agencies including NCQA

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.