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Positions in this family include those responsible for functions in areas such as health services, clinical services and delivery of clinical care.
Positions in this function are responsible for direction and guidance on clinical quality improvement and management programs including accreditation and health plan delegation. Conducts clinical quality audits and may also be responsible for NCQA requirements. Responsible for the reporting and analysis of member care quality and for the development of plans and programs to support continuous quality improvement.
General Job Profile
- Manages and is accountable for professional employees and/or supervisors
- Impact of work is most often at the local level
You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
- Sets team direction, resolves problems and provides guidance to members of own team
- May oversee work activities of other supervisors
- Adapts departmental plans and priorities to address business and operational challenges
- Influences or provides input to forecasting and planning activities
- Product, service or process decisions are most likely to impact multiple groups of employees and/or customers (internal or external)
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.
Years of post-high school education can be substituted/is equivalent to years of experience
- Current, unrestricted RN compact license
- 5+ years of clinical experience
- 2+ years of clinical quality experience
- 2+ years working in managed care or in the insurance industry
- 2+ years experience with Medicare and/or Medicaid
- 2+ years experience managing licensed and unlicensed employees
- Experience presenting to executive leadership, internal/external auditors, including developing presentations, reports in excel
- Knowledge base of clinical standards of care, preventive health standards, NCQA, governing and regulatory agency requirements
- Proficiency in software applications that include, but are not limited to, Microsoft Word, Microsoft Excel, Microsoft PowerPoint
- Proven ability to evaluate medical records with attention to detail to perform quality audits
- Proven solid organizational skills, self-motivated and ability to interact with company staff at all levels
- Ability to travel 15% (as needed) to visit contracted Providers/Vendors
- Access to reliable transportation that will enable you to travel to client/patient sites
- CPHQ certification
- Experience with project coordination and project management
- Subject matter expert for CMS
- Demonstrated ability to assist with focusing activities toward a strategic direction as well as develop tactical plans, drive performance and achieve targets
California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The salary range for California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island or Washington residents is $85,000 to $167,300 per year. 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.
*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
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: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment