DSNP Medicare Quality Manager – Hawaii

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.

 

Are you a leader and subject matter expert in healthcare quality?  Do you want to help lead Medicare quality improvement in STARs, scope definition, risk identification, methodology and resource allocation or facilitation? Lead strategic initiatives crossing business teams and operating groups as our Medicare Quality Lead to coordinate and complete projects, define performance, root cause analysis, develop and execute strategies, and innovate and drive local initiatives. You will determine time frames, procedures for accomplishing project, and lead others in the organization to make meaningful process improvements. Assess, develop, coordinate, and implement strategies to align with national Medicare quality activities including Stars.  Assess provider network incentive status, data acquisition mechanisms and drive provider oversight towards gap closures and participate in HEDIS data capture in coordination with the health plan Quality Director.

 

If you reside in Hawaii and able to travel up to 50% of the time, you’ll enjoy the flexibility to work remotely * as you take on some tough challenges. 

 

Primary Responsibilities:

• Monitor/manage STARs measure performance and drive the health plan’s DSNP/Medicare quality and related performance measures
• Report to health plan’s leadership team on progress, challenges and opportunities on DSNP/Medicare quality metrics and goals on a regular basis
• Develop strategies related to overall STAR performance and create alternate plans to impact HEDIS/CAHPS measures
• Monitor and evaluate all initiatives impacting population and adjust strategy as needed in consultation with National STARs team and Member Navigation Team to determine mix of channels and delivery systems to drive 5 STAR ratings
• Perform root cause analysis for poor performance on administrative and clinical measures
• Coordinate within the plan and across functional areas to resolve and/or improve STAR and HEDIS measures
• Develop and execute overall STARS strategy in collaboration with plan leadership and National STARS team with flexibility to attend meetings outside of Hawaii business hours
• Innovate and drive local initiatives that address low performing measures
• Manage local plan personnel as needed, and other functional areas to develop CAHPS interventions and Disenrollment Reduction Initiatives
• Monitor overall compliance and metrics in our pay for performance / quality programs with providers related to our DSNP/Medicare program
• Monitor and work with Regulatory Reporting and Compliance teams to ensure health plan performance with DSNP/Medicare quality and related requirements are met
• Participate in audits as appropriate
• Provide subject matter expertise in STARS, HEDIS, project plans, reporting logistics, etc.
• Work with assigned providers, state, and community agencies

 

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 in a healthcare quality improvement role
• 3+ years of experience in developing reports, working with large data sets and making data – driven analytical decisions
• 2+ years of STARS experience
• Demonstrated ability to focus activities toward a strategic direction and achieve targets and meet deadlines
• Comfortable communicating with executive leadership and external parties including physicians and other provider leaders
• Proven track record of reaching and / or exceeding performance improvement plans
• Work with minimal guidance; seeks guidance on only the most complex tasks and can translates concepts into practice
• Solid interpersonal skills and ability to excel in workgroup environment in different roles as required, i.e. group leader, subject matter expert or consultant, participant
• Intermediate or higher level of proficiency with MS Project, Excel, Visio, PowerPoint and SharePoint
• Demonstrated ability to communicate ideas clearly and concisely
• Excellent time management, organizational, and prioritization skills and ability to balance multiple priorities
• Ability to travel as needed up to 50% of the time
• Hawaii resident

 

Preferred Qualifications:

• STARs / HEDIS experience in healthcare
• Experience working in a highly matrixed organization
• Experience acting as a liaison between business, clinical, and technical teams
• Bi-Lingual
• Medicare Advantage health plan experience
• Project management experience

 

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

 

The salary range for this role is $89,800 to $176,700 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with al minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

 

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. 

 

 

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.     

 

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