Quality Program Manager/Quality Management Manager - Minnetonka, MN

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)

To promote our mission of helping people live healthier lives, the Quality Manager coordinates critical components of our quality management program in compliance with regulatory requirements and NCQA accreditation standards. The Quality Manager works within highly matrixed relationships to implement and maintain the core infrastructure of quality management program, incorporating all products and populations served by the health plan. This position collaborates with multiple functions that may include Clinical, Physician Engagement, Member Experience, Benefit Design/Product, Compliance, Network, Behavioral Services, and Pharmacy as needed to support the quality management program.

Primary Responsibilities:

• Oversees the implementation of plan quality management components, including quality management committee oversight and governance structure
• Proactively manages and responds to rapidly changing state requirements and environments
• Collaborates across business segments to attain or maintain the plan’s compliance with NCQA accreditation standards and contractual requirements as they apply to the quality management program
• Develops and maintains positive relationships with the state External Quality Review Organization (EQRO) within the scope of the quality management program
• Ensures the creation, integration, maintenance, approval, and submission of the Trilogy Documents, including but not limited to the Program Description, Work Plan, Evaluation, and policies and procedures
• Ensures the creation and submission of reports to meet state contractual requirements including Performance Improvement projects (PIPs)
• Directs as applicable process improvement plans and corrective action plans for surveys, accreditations, EQRO and regulator audits within the scope of the quality management program
• Monitors HEDIS reporting requirements and annual reporting processes to confirm alignment with regulatory expectations and successful annual submission
  

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 healthcare related field, or comparable experience
• 5+ years of experience with demonstrated functional knowledge related to regulatory adherence of a quality management program (HEDIS, NCQA accreditation, EQRO auditing, reporting, committee management
• Solid written and oral communication skills with internal and external partners and employees
• Experience making formal presentations in front of committees and work group environments and using virtual technology (e.g., Microsoft Teams/WebEx)
• Advanced level proficiency in software applications that include, but are not limited to, Microsoft Word, Excel, Outlook, and PowerPoint
• Knowledgeable about the managed care/health insurance industry, products, and services
  

Preferred Qualifications:

• Master’s degree in healthcare, or similar area
• Certified Professional in Healthcare Quality
• Experience in bringing together cross-functional teams to complete projects
  

Soft Skills:

• Demonstrated ability to assist with focusing activities on a strategic direction as well as develop tactical plans, drive performance, and achieve targets
• Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action
• Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others
• Ability to influence, interact, and negotiate with medical staff, peers, and internal company staff at all levels
• Commitment to anticipating, understanding, and meeting the needs of internal and external customers
  

UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.

Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low-income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.(sm)

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.

Job Keywords: Quality Improvement, Quality Management, HEDIS, Accreditation, NCQA, Healthcare, Compliance, Regulator, CPHQ, Managed Care, Minneapolis, MN, Minnesota, UHC, UnitedHealthcare