1+ months

Senior Manager Clinical Quality San Antonio TX - 921863

San Antonio, TX 78205
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  • Job Code
    921863

Do you have compassion and a passion to help others?Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieveyour lifes best work.(sm)

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The Senior Manager,Clinical Quality is responsible for coordinating and implementing the STARs data collection and works in collaboration with the Director of Quality to develop strategies for achieving a 5 STAR rating. This role assists with data analysis and report preparation for all required data submissions. The Clinical Quality Managerprovides direction and support to the various WellMed markets in the implementation of strategies for closing care gaps. This role works closely and collaboratively with various functional areas of the delivery system to achieve the goals and objectives of the Quality Improvement Program.

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Primary Responsibilities:

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  • Provide leadership and support in establishing the Quality Performance Initiatives at the market level
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  • Monitor and analyze large volume of electronic submissions for possible data deficit issues. Utilize internal audit tracking tools for review and validation of data integrity
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  • Collaborate with physicians to execute the implementation of the clinical quality initiatives as defined by enterprise
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  • Provide expertise to the training department on HEDIS / STAR measures and on the tools that support the collection of HEDIS / STAR data
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  • Work with IT on the interpretation of technical specifications and impact of HEDIS / STAR measures to the data collection tools and reports utilized for the support of HEDIS / STAR measures
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  • Conduct training on HEDIS / STAR measures, HEDIS / STAR data collection software and data collection strategies
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  • Participate in NCQA HEDIS or Health Plan audits
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  • Work with external vendors on data transmission issues
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  • Analyze data for possible data integrity and data deficits
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  • Analyze and trend HEDIS / STAR rates, identify barriers to improvement of rates and creating interpretive exhibits. Monitor and analyze large volume of electronic submissions for possible data deficit issues. Utilize internal audit tracking tools for review and validation of data integrity
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  • Analyze and trend HEDIS / STAR rates, identify barriers to improvement of rates based on HEDIS supplemental submission requirements via enterprise data systems and team work processes. Provide process improvement strategies to enterprise leadership for improving data capture and outcomes
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  • Develop operating budget as necessary
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  • Develop and/or maintains audit, policies and procedures that support the corporate initiatives that meet State, Federal legal requirements and standards
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  • Provide expertise to the training department on HEDIS measures and tools that support collection of and communication about HEDIS to the enterprise
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  • Work with Enterprise on developing and implementing HEDIS member engagement strategies
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  • Promote understanding, communication and coordination of all quality improvement program components
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  • Coordinate reporting on quality initiatives to all appropriate committees
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  • Develop operating budget as necessary
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  • Maintain QI program documents, reports, and committee minutes and follows all internal privacy and confidentiality policies and procedures
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  • Update QI Project templates and Work plan with assigned responsibilities
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  • Attend and participate in all QI meetings
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  • Perform all other related duties as assigned
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Youll 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.

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Required Qualifications:

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  • Bachelors degree in Registered Nursing or related field
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  • 5+ years of healthcare experience to include experience in a managed care setting
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  • 3+ years of experience with data analysis
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  • HEDIS / STAR experience or participation with regulatory reporting
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  • Basic understanding of quality improvement standards such as NCQA, HEDIS, CAHPS, HOS and CMS
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  • Experience working with people at all levels in an organization
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  • Advanced level of proficiency with Microsoft office applications, including but not limited to databases, word-processing, spreadsheets, and graphical displays
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  • You will be asked to perform this role in an office setting or other company location
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  • Employees are required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener prior to entering the work site each day, in order to keep our work sites safe. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained
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Preferred Qualifications:

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  • Masters (MBA, MHA, MPH, MN or related field)
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  • CPHQ Certification
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  • CHCQM Certification
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  • 3+ years of process management experience
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  • Healthcare Quality Improvement experience
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  • Excellent training and presentation skills with solid communication capabilities and practices, both oral and written
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  • Demonstrated effective organizational skills
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  • Excellent communication, writing, proofreading and grammar skills
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  • Solid attention to detail and accuracy, excellent evaluative and analytical skills
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  • Solid teamwork, interpersonal, verbal, written, and administrative and customer service skills
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Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 550,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)

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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.

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UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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"Job Keywords: WellMed, San Antonio, Dallas, Austin, Houston, El Paso, TX, Texas

Posted: 2021-05-15 Expires: 2021-07-14

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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Senior Manager Clinical Quality San Antonio TX - 921863

UnitedHealth Group
San Antonio, TX 78205

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