Network Quality Manager - Remote

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.

The Network Quality Manager is responsible for operational quality oversight, governance, monitoring, reporting, audit readiness, and quality improvement activities supporting provider data operations across medical and dental networks. This role ensures provider data integrity, provider directory accuracy, network adequacy support, credentialing quality support functions, and exception/fallout management activities are monitored and aligned with contractual, regulatory, and operational requirements. This role supervises and manages daily operations of auditors and analyst team. Quality manager is responsible for end-to-end and all aspects of quality business process activities to include quality planning, quality assurance, quality control and quality improvement. Quality manager supports risk reduction, auditing life-cycle activities, cost and productivity savings, reporting, and quality improvement initiatives. Monitors performance and completes system analysis in specific areas of quality to include: Claims, Appointment Scheduling, Provider Data, Customer Service, and Appeals & Grievances. The role partners cross-functionally with Provider Data Operations, Network Operations, Network Adequacy, Credentialing, Compliance, and Quality teams to support provider network reliability, operational performance, and enterprise quality objectives within the VA Community Care Network (CCN) program environment.

Sets team direction, resolves problems and provides guidance to members of own team. Adapts departmental plans and priorities to address business and operational challenges. Influences or provides input to forecasting and planning activities.

This role supports:

• Increase of quality metrics for operational business units
• Audit Calibrations with internal and external partners
• Audit Governance: Approves audit methodologies, sampling plans, and scoring standards
• Reporting & Stakeholder Communication
• Cost / productivity savings
• Risk reduction
• Error / defect reduction
• Process waste reduction
• Continuous improvement efforts

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Supervise and manage daily operations of auditors and analyst team
• Lead operational quality oversight activities related to provider data integrity and provider network quality performance
• Monitor provider data quality trends, fallout, automation exceptions, audit findings, and operational performance indicators
• Support audit readiness activities, quality assurance reviews, and corrective/preventive action management
• Ensure compliance with Quality Assurance Plan (QAP), QASP, contractual, regulatory, and operational quality requirements
• Oversee quality monitoring and reporting activities related to provider directory accuracy, network adequacy support, and credentialing support functions
• Identify operational risks, process gaps, and quality trends impacting provider network reliability and customer experience
• Lead quality improvement initiatives focused on operational efficiency, risk reduction, data integrity, and process standardization
• Partner with operational leaders and stakeholders to support quality governance, escalation management, and issue resolution activities
• Support development and maintenance of operational controls, quality documentation, monitoring plans, and audit artifacts
• Analyze operational data and performance metrics to identify trends, improvement opportunities, and potential compliance risks
• Facilitate cross-functional collaboration to improve operational alignment and strengthen provider data quality processes
• Support implementation of process improvements, monitoring controls, and operational governance activities across provider data operations standards
• Addresses special (ad - hoc) projects as appropriate; Performs special project audits and reviews as requested by other departments/regions

Functional Responsibilities

• Provider data quality monitoring
• Provider directory quality oversight
• Network adequacy quality support
• Credentialing quality support functions
• Audit and compliance readiness
• Operational risk identification and mitigation
• Corrective and preventive action management
• Operational reporting and data analysis
• Exception and fallout management
• Quality governance and process improvement

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:

• 2+ years of Team Lead/SME experience with demonstrated abilities in the following soft skills: Leadership and Emotional Intelligence success leading teams to deliver results and meet goals
• 1+ years of auditing experience
• 1+ years of experience analyzing and solving customer problems
• Experience supporting quality, operational oversight, provider data, network operations, credentialing, compliance, or related operational functions with demonstrated understanding of basic quality programs
• Experience working with operational metrics, reporting, quality monitoring, and process improvement activities
• Experience working independently in less structured environments with moderately complex operational issues
• Experience communicating operational risks, findings, and recommendations to leadership and stakeholders
• Ability to work Monday - Friday, 8:00 am - 5:00pm in Central Time Zone

Preferred Qualifications:

• Lean, Six Sigma, Quality, HRO, or process improvement experience
• Experience supporting healthcare operations, provider data operations, network management, or quality assurance programs
• Experience supporting contractual quality requirements, audit readiness, or compliance monitoring activities
• Experience with quality management systems, operational controls, or performance monitoring frameworks
• Knowledge of provider directory operations, provider data management, network adequacy requirements, or credentialing operations

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

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). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $72,800 to $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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.    

OptumCare 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.  

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.