Clinical Quality Manager - Remote in Pennsylvania

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 optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together 

The Quality Management Manager will monitor and support the health plan quality improvement initiatives with particular emphasis on HEDIS, NCQA, and State Performance measures. You'll act as a voice for our members, guiding the development of comprehensive care plans that will help others live healthier lives.

 If you are located in Pennsylvania, you will have the flexibility to work remotely* as you take on some tough challenges. This position will travel up to 10% in the PA market.

 Primary Responsibilities: 

• Oversee the implementation of plan's quality improvement program (QAPI)
• Work to coordinate the work with the clinical, operations, and network teams to improve HEDIS and NCQA performance and to close gaps in care
• Manage Quality work plan programs and activities
• Collaborate across local and national business segments to achieve goals and targets
• Develop and maintain positive relationships with external state organizations within the scope of Quality Management
• Continuously monitor HEDIS, NCQA, and state performance measure results and adjust programs to ensure targeted goals
• Support Performance Improvement Projects, accreditation, and regulatory audits as needed
• Develop and mentor quality department staff
• Oversee quality quarterly review meetings with state partners
• Serve as panelist for grievance and appeal hearings

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: 

• RN License in the state of Pennsylvania AND/OR Master's degree in a Healthcare Field (e.g. Public Health, Health Administration, Health Education, etc.) 
• Experience with HEDIS and NCQA - quality improvement project experience
• Experience managing staff or staff mgmt. for projects
• Experience writing reports and managed care industry
• Experience with outside audit organizations such as External Quality Review Organizations (EQROs) 
• Reside in the state of Pennsylvania and ability to travel up to 10% in the PA market

 Preferred Qualifications:  

• 2+ years demonstrated Management experience with responsibility for team performance management
• Quality improvement experience within a health plan
• Experience with excel (working with pivot tables) and creating PPT presentations
• Medicaid experience
• Clinical experience/background
• Ability to make independent decisions
• Change management experience and demonstrated skills
• Ability to complete various deliverables utilizing scholarly writing and AI technology
• Experience with outside audit organizations such as External Quality Review Organizations (EQROs) 
• Experience with managed care and insurance industry 
• Experience in writing reports and analyzing performance data 
• Experience creating detailed reports and project management

*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 $91,700 to $163,700 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 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.    

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.