Clinical Quality Manager - Accreditation Specialist - Grand Junction, CO

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

If you reside near Grand Junction, CO, you will enjoy the flexibility to telecommute* as you take on some tough challenges.

Schedule: Monday to Friday 8am to 5pm.

Candidates must be based within a comfortable commute of Grand Junction, Colorado.

Primary Responsibilities:

• Works collaboratively with various internal and external entities and individuals in accordance with the Mission and Values of the company to assist in maintaining and enhancing RMHP’s reputation as the leader in managed health care. Provides leadership by example to embed the organizational philosophy and culture
• Respect confidentiality and maintain confidences as described in the UHG Employee Handbook and acknowledged through signature by all employees. The ability to maintain confidentiality is a critical and essential component of this position
• Professional writing for the development or updating of the QI Program Description, QI Work Plan, and QI Annual Analysis
• Develop, update and review policies and procedures to meet State, Federal and Accreditation standard requirements
• Quality Program committee tracking of deliverables and written communications. Participation on various QI Committees for the gathering of complex information to support Quality Program and Accreditation activities that includes facilitation, scheduling, presentations, and documentation of meeting results
• NCQA Health Plan and Health Equity Accreditation expert knowledge of NCQA standards, processes and policies for the interpretation, identification of gaps in compliance or performance, application, and creation of documents to meet standard requirements
• Provide explanations and interpretations within area of expertise. Perform/participate in assessments, audits, and NCQA file reviews. Assist with corrective action plans based on findings
• Collect quality data and/or information based on applicable standards, state/federal regulations, internal requests, quality program requirements or project assignments. Identify appropriate sources and develop effective methods for data/information collection
• Analytical report writing that includes interpretation of trended data (e.g., clinical administrative, quality) and performance of quantitative and qualitative analysis with the identification of opportunities for improvement. Evaluate goals and effectiveness of interventions over time. Identify inconsistencies and trends
• Work to close gaps on identified problems. Work cross functionally and coordinate with both internal and external staff and develop interventions or recommendations
• Utilize computer systems to identify and annotate information for accreditation documentation preparation and submission to NCQA
• Read and interpret NCQA standards, policies and procedures and/or technical measure specifications. Provide explanations and interpretations within area of expertise to stakeholders and leadership
• Manage quality projects by defining project scope and develop project plan, coordinate with others and set appropriate deadlines when necessary. Manage relationships to ensure milestones are achieved and objectives met. Leverage expertise to influence decision making and program development
• Communicate quality data verbally and in writing. Identify, prioritize, and proactively communicate potential barriers or risks to key stakeholders. Educate, motivate and or influence others for understanding of applicable standards, gaps and or changes. Serve as a resource providing explanations, information and expertise to others
• Develop, facilitates and maintain strong relationships with organization in their area of specialty to build trust, align work, and ensure successful accreditation outcomes
• Serves as a valuable resource externally and cross-functionally within the organization
• Uses a systematic approach and critical thinking skills to assist in guiding the team to create highly functioning teams across RMHP
• Utilizes interpersonal and meeting facilitation skills to attend and participate in meetings as necessary and directed by the manager. Provides information and recommendations based on knowledge in their area of specialty. Integrates and collaborates with other departments as requested by the Manager
• Develop and maintain strong working relationships with RMHP employees and other external stakeholders
• Utilizing established measurements to monitor ongoing progress towards achieving sustainability on NCQA Accreditation processes and QI Program requirements
• Facilitate the use of available health information technology resource opportunities to improve overall health plan efficiency and improved outcomes
• Structure, coordinate and facilitate consistent team meetings using specified models so that other staff will have the ability to conduct efficient and effective team meetings and increase team independence
• Utilize individual thought to develop, organize and evaluate data to resolve problems or determine course of action
• Coordinate with RMHP analytical staff & Clinical Staff to present Quality Program or Accreditation data to appropriate teams
• Collect quantitative and qualitative data from internal and external stakeholders based upon applicable standards, state requirements, internal requests or projects (i.e., NCQA accreditation)
• Investigate quality problems identified and collect additional information to close gaps and drive performance
• Analyze and interpret data or information (e.g. Clinical, administrative, quality) to ensure they meet standards, are accurate, complete and compliant
• Develop and update work plans to ensure projects are completed in a high quality, timely manner
• Communicate RMHP metric performance and progress to senior leadership, core team, and the Quality Improvement Committee effectively
• Read and interpret standards/requirements for State/federal contracts, NCQA accreditation, etc
• Use excellent organizational skills, professional demeanor and tact to support various Quality Improvement activities
• Use self-direction, intuition, and flexibility to anticipate needs and act proactively to ensure departmental goals are met
• Educate, motivate and/or influence others to own RMHP performance metrics and commit to the quality improvement process
• Develop educational materials to help RMHP staff understand the RMHP Quality Program and Accreditation requirements and how everyone plays a role in quality improvement
• Support work required by Federal and State entities such as the Department of Healthcare Policy and Financing (i.e., timely submission of audit deliverables, etc.)
• Coordinate multiple, cross functional projects that result in achieving departmental goals
• Utilizes digital design to deliver high-quality communication via webinars, newsletters, email blasts, memo, etc
• Maintain the confidentiality of sensitive information obtained while managing the project

What are the reasons to consider working for UnitedHealth Group? Put it all together – competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
• Medical Plan options along with participation in a Health Spending Account or a Health Saving account
• Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
• 401(k) Savings Plan, Employee Stock Purchase Plan
• Education Reimbursement
• Employee Discounts
• Employee Assistance Program
• Employee Referral Bonus Program
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
• More information can be downloaded at: http://uhg.hr/uhgbenefits

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 in Analytics, Healthcare Management, Science, Nursing, Behavioral Health (or any related field) OR High School Diploma / GED with 3 years of experience in analytics or quality program experience and NCQA Accreditation
• Intermediate level of proficiency in Microsoft Office Suite (Excel, PowerPoint, Word, etc.)
• Must reside within a commutable distance of Grand Junction, Colorado

Preferred Qualifications:

• 1 years of experience in NCQA Health Plan or Health Equity Accreditation with expert knowledge of NCQA Standards and processes
• Experience with complex analytical report writing preferred
• Prior experience with Quality Program documents and processes preferred
• Prior experience with project management, critical thinking and decision making preferred
• Prior experience with cross-departmental meeting facilitation, gathering complex oral and written information from department leaders, and external partners, and interpreting/creating documented processes preferred.

• All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

The salary range for this role is $28.61 to $56.06 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.

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.

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