19 days old

Director of Quality - Iselin, NJ

Iselin, NJ 08830
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  • Job Code
    864398
Provides strategic leadership and direction for the quality improvement and management program(s) as a core service to Community & State Plans. The Director works within highly matrixed relationships to lead and develop the overall quality strategy for the plan, insuring the quality program is proactive, continuously improving, applies to all product and programs within the state, and includes both quality management/regulatory adherence and quality improvement. This position provides strategic insight and direction to the plan to align with a changing health care landscape as it applies to quality. The plan director is an active contributor in RFP responses, taking lead on the quality portion. This position develops and maintains strong relationships with state regulators, provides leadership input to expand and support provider engagement, and advocacy at the state level. This position coordinates across multiple functional areas including but not limited to: Clinical, Physician Engagement, Member Experience, Benefit Design/Product, Compliance, Network, Behavioral Services, and Pharmacy as needed to support the quality outcomes.

€ Quality Improvement
€ Quality Management/Regulatory Adherence
€ Advocacy and Relationship Management, Internal and External
€ Fiscal Management
€ Employee Engagement and Development

Major Responsibilities

€ Oversees the development and implementation of plan quality program including creating strategic partnerships with internal and external stakeholders to ensure a holistic and comprehensive quality program
€ Works to coordinate the work across HEDIS Operations and Data Collection, Data Analytics and Reporting, Accreditation, Member Surveys, Regulatory Adherence, Member Activation and Engagement, Medical Quality Applications, and other matric partners, utilizing the expertise, standard process, and capabilities of these areas to enhance quality program performance of the plan.
€ Creates a comprehensive Quality Improvement plan, playbook and quality targets that links to contractual and regulatory obligations, value based contracting and other HP identified initiatives.
€ Oversees and directs, as applicable , quality improvement activities and interventions to close gaps in care and improve outcomes for identified critical quality measures.
€ Ensures strong HEDIS and Stars performance.
Cultivates a strong working relationship across business segments to attain or maintain the Plan's compliance with accreditation standards and contractual requirements as they apply to quality.
€ Develops Provider Incentive Program Outreach Strategy, and oversees the field team that supports providers on quality improvement and clinical data acquisition.
€ Develops and maintains positive relationships with State Agency stakeholders and State External Quality Review Organization within the scope of Quality Management and Improvement.
€ Oversees and insures the creation, integration, maintenance, approval, and submission of the trilogy document, including but not limited to Quality Program Description, Work Plan, Evaluation, and Program Policies and Procedures.
€ Oversees and insures the creation and submission of reports to meet state contractual requirements including Performance Improvement projects (PIPs)
€ Insures and oversees Health Plan Quality Management /committee structure and integrated quality oversight processes.
€ Oversees and directs as applicable process improvement plans and corrective action plans for surveys, accreditations, EQROs, and state audits, within the scope of Quality Management and Improvement.
€ Represents and gives input to the RFP process as it applies to quality.
€ Interviews, hires, and supervises quality department staff.
€ Develops, mentors, and coaches staff.
Provides, through partnership with the Chief Medical Officer, strong leadership for the local quality team and integration with the New Jersey Community and State clinical organization to meet the overall strategic quality goals of the Health Plan.

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Posted: 2020-03-20 Expires: 2020-04-20

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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Director of Quality - Iselin, NJ

UnitedHealth Group
Iselin, NJ 08830

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