SanJoseCARecruiter Since 2001
the smart solution for San Jose jobs

West Region Director of Clinical Quality - STARs Strategy - Telecommute in West Region

Company: UnitedHealth Group
Location: San Jose
Posted on: September 24, 2022

Job Description:

UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm) We have made a promise to the seniors we serve that we will support more effective care with networks focused on quality outcomes, a patient-centered clinical model and more members in high-quality rated plans - all delivered at the lowest medical costs and meeting and exceeding the expectations of CMS. The Director of West Region Clinical Quality is accountable for both defining the strategy, innovation to drive 80% of our WR contracts into a 4-4.5 STAR plan The Director of Clinical Quality must ensure all stakeholders are coordinating to drive high quality performance across the region. If you are located in the West Region of the United States, you will have the flexibility to telecommute as you take on some tough challenges. Primary Responsibilities:

  • Devise, communicate, monitor and intimately understand the regional path to 4.5 stars and coordinate with Regional Quality Field Organization and M&R leadership on all activities that ensure 4 - 4.5 star performance is achieved
  • Be considered the center of the Clinical Quality Strategy; may include but not be limited to mining data to find all opportunities for performance improvement in all aspects of Stars performance including HEDIS Part C and Health Outcomes Survey Measures
  • Create a year-round Clinical Quality Strategy to positively impact chart and decrease the need to collect charts
  • Actively coordinate with all Medicare & Retirement national functions (Product, Sales, Marketing, Member Experience, Finance), UnitedHealthcare shared services functions (Network, Clinical, Quality, Operations), Optum (Local Care Delivery, HouseCalls, Complex Population Management), lines of business (M&R, DSNP, ISNP, Group) and local leadership (Local EDs, CEOs) to leverage local market knowledge and establish and drive local tactical plans for improving CMS Star ratings and quality
  • Coordinate with Network and Optum teams to provide H-Plan Leads, Practice Performance Managers and embedded Practice Resources strategic direction; approve performance targets / metrics; ensure performance to targets. Includes positive physician HEDIS run-rate performance; development of new and existing strategies, innovation, and to be a thought leader in this space for the region
  • Partner with current vendors to maximize strategies and also explore new potential vendors that may positively impact the Clinical Quality Measures
  • Meet all assigned performance targets
  • Maintain strong relationships with Medicare & Retirement national functions, UnitedHealthcare shared services functions and Optum businesses through regular communications and face to face contacts
  • Exemplify and model Our United Culture and live our values with conviction 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:
    • Bachelor's Degree
    • 7+ years of experience in a large, complex and successful health care / managed care organization with demonstrated track record of increasing responsibility and accountability
    • Proven in-depth experience with health care providers and networks
    • Proven experience with clinical quality improvements, including HEDIS measures and CMS STARs ratings
    • Clinical background
    • Comfort and ability to travel 25% within the West Region
    • Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation Preferred Qualifications:
      • Experience in a Medicare Advantage business
      • Registered Nurse
      • Solid written and verbal communication skills, including well-developed interpersonal skills used to influence the behavior of others across a highly-matrixed organization
      • Demonstrated success building relationships with external executives and stakeholders
      • Track record of meeting business goals via driving disciplined, fact-based decisions and executing with discipline and urgency To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment. Careers at UnitedHealthcare Medicare & Retirement. The Boomer generation is the fastest growing market segment in health care. And we are the largest business in the nation dedicated to serving their unique health and well-being needs. Up for the challenge of a lifetime? Join a team of the best and the brightest to find bold new ways to proactively improve the health and quality of life of these 9 million customers. You'll find a wealth of dynamic opportunities to grow and develop as we work together to heal and strengthen our health care system. Ready? It's time to do your life's best work.(sm) All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy. Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado/Connecticut/Nevada residents is $113,500 to $218,100. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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. 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.

Keywords: UnitedHealth Group, San Jose , West Region Director of Clinical Quality - STARs Strategy - Telecommute in West Region, Healthcare , San Jose, California

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category

Log In or Create An Account

Get the latest California jobs by following @recnetCA on Twitter!

San Jose RSS job feeds