VA DSNP Stars & Quality Performance Lead

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The VA DSNP Stars & Quality Performance Lead supports the operation of the DSNP plan from a clinical and quality perspective. This role is instrumental in supporting and leading an operationally and financially sound health plan in partnership with Virginia's DSNP Executive Director and other key health plan leaders.

This person oversees day-to-day operations and projects that deliver improved quality outcomes and clinical intervention strategies. She/he is responsible for leading a variety of clinical and quality review meetings and providing direction to both the health plan Quality Director and the clinical teams to institute interventions that will directly impact quality outcomes. In addition, this person is responsible for triaging all DSNP provider, member, and network issues. The VA DSNP Stars & Quality Performance Lead will work with appropriate SMEs to resolve issues and follow up with stakeholders on resolution status and actions.

In total, C&S employs over six-thousand employees and serves five-million members in 24 states and the District of Columbia. C&S is the largest health benefits company dedicated to the economically-disadvantaged, medically underserved and those without employer-funded health care coverage.

This role will report to the health plan's Quality Director within the Community Plan of Virginia with a strong dotted line to the Executive Director, DSNP. This role will be responsible for supporting the C&S DSNP product in addition to partnering/supporting aspects of the Medicare & Retirement (M&R) products including quality, inclusion in ACO agreements and clinical interventions to support STARs improvement. 

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Preference for those in EST.  Willingness to work EST hours required.

Potential for up to 10% of travel.

Primary Responsibilities:

• Serve as the VA DSNP expert in monthly reviews of all clinical programs. Review operational and financial impact metrics and lead remediation efforts as necessary to support STARs quality and financial goals
• Lead the development of clinical interventions in partnership with health plan leaders to improve health outcomes and quality scores. Manage the implementation of clinical interventions with our clinical partners
• Serve as the Issue Resolution Lead for VA DSNP.  Review all issues as received and manage issue resolution with organizational SMEs
• Perform monthly reviews of member and provider complaints for trends and lead resolution development. Manage resolutions with appropriate SMEs
• Manage the development of reporting to meet SMAC requirements and support the Executive Director in developing reports for the State
• Manage and serve as the clinical SME for the STARS Quality Lead in partnership with M&R
• Manage the ACO and MAPCPi contracting process in partnership with M&R and UHN
• Serve as the SME for all Medicare materials (accuracy and CMS compliance) in partnership with the UHC compliance officer
• Monitor benefits utilization and identify trends and gaps in utilization. Lead the analysis to determine needed benefit changes.Partner with M&R product and sales teams to review benefit options and make recommendations to the Virginia Executive Director, DSNP
• Manage ancillary benefit providers including the development and regular review of meaningful KPIs
• Supports the Executive Director in reviewing CTMs (Complaints to Medicare) and Appeals & Grievances; and escalating as appropriate
• Ad hoc projects 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 healthcare quality, clinical quality, or quality-program experience
• 3+ years of Medicare Advantage, D-SNP or Stars experience 
• 3+ years of experience in evaluating clinical and quality programs for improved outcomes and interventions 
• 3+ years of experience analyzing large datasets and translating findings into operational action
• Intermediate level of proficiency with Excel

Preferred Qualifications:

• Degree in nursing, healthcare administration, public health, business or a related field, or equivalent experience
• Analytical skills and comfort with manipulating reports and datasets
• Verbal, written, interpersonal and presentation skills
• Ability to collaborate and integrate multiple perspectives; yet are willing and able to be decisive in service of a strategic vision
• Solid communicator; capable of effectively presenting ideas and selling concepts and tactics; ability to conceptualize and effectuate change management and "out-of-the-box" thinking
• Excellent relationship building skills (communication, negotiation, influencing, listening) and comfort engaging and influencing senior and executive level staff
• Demonstrated ability to drive strategy and planning with clinical leaders and influence matrix and internal/external partners
• Demonstrated ability to handle pressure, tension, ambiguity, changing priorities, and multiple viewpoints in a manner consistent with UnitedHealth Group's core values

*All Telecommuters 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.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. 

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.

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.

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