Clinical Program Manager – Remote in OH

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The Clinical Program Manager is responsible for quality improvement activities within the United Healthcare Community Plan of Ohio market. This role will take lead on identifying areas of opportunity within HEDIS and STARS measures and driving performance through improvement projects.  The individual in this position will work closely with Health Plan Clinical and Population Health departments to implement the Health Plan’s MMP and DSNP performance improvement programs and key activities through oversight, performance monitoring and support, relationship management and engagement, and quality improvement. This position is accountable for driving execution of performance improvement transformation, while meeting the program expectations outlined by the State. The Clinical Program Manager will directly report to the Quality Improvement Manager.

 

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

Primary Responsibilities:

• Analysis of STARS and HEDIS measures to support operational strategy and population health initiatives
• Heavy focus on leading MMP HEDIS and Quality Withhold performance improvement and management of a portfolio of solutions to manage at risk dollars associated with Quality performance
• Ability to apply data analytic and evaluation skills to identify areas of opportunity in managing Quality portfolio
• Liaison to the population health team to promote cross-pollination of quality improvement strategies across all organizational contracts
• Coordinate with multiple internal departments to help align the resources, products, and support necessary to promote success in aligning to HEDIS and STARS performance
• Liaison with key internal stakeholders and partners to forward the organization’s Quality and Population Health strategy, principles, and practice
• Application of the principles of Quality Improvement Science with all improvement projects
• Develop and manage the health plan’s portfolio of MMP and DSNP improvement projects, including ensuring impact at a population level
• Accountable for building and leaning into relationships with internal and external partners to meet or exceed market Quality goals

Skills and Abilities:

• Ability to focus energy on serving diverse patient populations
• Problem-solving experience in changing utilization patterns and trends
• Ability to lead and influence multidisciplinary teams to include external stakeholders for highly complex topics
• Self-directed, independent and track record of problem solving, initiation and leadership for extremely complex, visible and multifaceted topics
• Demonstrated ability leading across organizational silos when presented with highly complex and undefined work
• Ensure alignment and understanding of population scope and objectives with the organization’s strategic objectives and the Voice of the Customer, in consultation with all applicable stakeholders
• Possess strong listening skills, demonstrated by high level of responsiveness and follow through
• Experience in challenging «the way it has always been done”
• Comfortable working through ambiguity toward clarity around data specifications and sources
• Demonstrated ability to make recommendations and implement improvement interventions based on results of monitoring of the utilization management program
• Converts data into useable information, and measures the impact of improvement initiatives
• Demonstrated ability to communicate ideas clearly and concisely at all levels
• Ability and desire to lead and continuously improve and evolve Quality programs
• Strong verbal and written communication skills, including ability to present and speak in public forums
• Collaborative spirit – internal and external to the organization
• Flexibility in daily work schedule and task assignment
• Proven ability to prioritize and multi-task
• Advanced skills in MS Office, Microsoft Project, Microsoft PowerPoint, Microsoft Excel, Microsoft Visio, Microsoft Outlook, and Microsoft Edge
• Model and demand integrity and compliance with all company policies, and local, state, and federal regulations
• Proven ability to execute and drive improvements against stated goals
• Ability to develop relationships with network and community physicians and other providers
• Ability to successfully function in a matrix organization exhibiting the culture of United Health Group
• Maintain a patient-focus

Essential Characteristics:

• Strong leadership skills to drive performance
• Dependable, self-directed and organized
• Ability to manage deadlines and work under pressure
• Discrete/ability to maintain confidentiality
• Strong attention to detail
• Sense of urgency and accountability
• Ability to work well independently and take direction
• Ability to lead and influence Health Plan employees by fostering teamwork and collaboration, driving employee engagement, and leveraging diversity and inclusion
• Communicate and present effectively, listen actively and attentively to others, and convey genuine interest
• Ability to travel on an as-needed basis

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

• Be full-time and based (working) in the state of Ohio
• 3+ years of progressively responsible professional experience in data management, service coordination, ambulatory care, community public health, case or care management, or coordinating care across multiple setting with multiple providers
• Experience in actively applying or overseeing the application of science-based quality improvement methods to reduce health disparities  
• Advanced to expert level of proficiency with MS Project, Excel, Visio, PowerPoint, TEAMS, and SharePoint  
• Experience working with and leading cross-functional teams and projects
• Excellent time management, organizational, and prioritization skills and ability to balance multiple priorities
• Solid problem solving and analytical skills
• Ability to influence and work with all levels of internal and external stakeholders/resources to move quality improvement projects and programs forward and overcome any challenges
• Excellent communication skills both written and verbal
• High emotional intelligence and ability to manage multiple simultaneous tasks
• Attention to detail with impeccable organization skills
• Training / Certification in quality improvement science or obtain within six months of hire
• Experience pertinent to the complex patient population(s) being managed
• Experience in managed care
• Solid knowledge of health insurance industry utilization trends and reimbursement methods
• Experience with key-driver diagrams, flowcharts, Pareto diagrams, histograms, scatter diagrams, run and control charts
• Ability to travel up to 10% statewide throughout OH

Preferred Qualifications

• Project management or active project participation experience
• PMP® Certification
• Experience working with Medicare, Medicaid and DSNP populations and the utilization nuances of each patient population
• Tableau-BI experience
• Solid data analysis and interpretation skills; ability to focus on key metrics
• Strong team-player and team-building skills
• Strategic thinking with proven ability to communicate a vision and drive results  
• Creative problem-solving skills with proven track record of success
• Hands-on experience and mastery of Quality Improvement principles
• Experience in a highly regulated environment

Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That’s why you’ll find some of the most amazingly talented people in health care here. We serve the health care needs of low-income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical, and environmental factors. Join us. Work with proactive health care, community, and government partners to heal health care and create positive change for those who need it most. This is the place to do your life’s best work.^SM

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

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.