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Job Details
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. This position will be responsible for coordination of care for the EPSDT aged members to meet EPSDT quality and performance measure goals. Responsible for direction and guidance on Clinical Quality improvement and management of Performance Improvement measures. Responsible for the development and implementation of data collection methodology to meet or exceed minimum performance standards established by the regulator, reporting and analysis of clinical performance measures and performance improvement projects. You’ll enjoy the flexibility to work remotely* from anywhere within the Commonwealth of Kentucky with up to 25% local in-state travel including meetings in the Louisville Office twice a month and attending some community and member facing events and conferences. Primary Responsibilities:
- Accountable owner of HEDIS Childhood and Adolescent measures including, but not limited to, WCV, IMA, CIS, and WCC
- Provide annual evaluation of EPSDT program design and efficacy as well as development of work plans to address performance improvement
- Develop and submit EPSDT requiring reporting including DMS and CMS reporting
- Collaborate with multiple functions that may include Clinical, Physician Engagement, Member Experience, Benefit Design/Product, Compliance, Network, Behavioral Services, and Pharmacy as needed to drive the EPSDT quality improvement program
- Initiate program improvement projects and activities to drive outcomes to impact EPSDT measures
- Implement policies and procedures to align with program goals and compliance requirements
- Represent the health plan and provide subject matter expertise as the EPSDT lead at internal clinical and quality meetings, regulatory meetings, and any relevant community partner meetings, workgroups, etc.
- Examine data and/or information to identify inconsistencies, trends, other information needed
- Analyze and interpret data or information to ensure they meet standards, are compliant and/or are accurate and complete
- Manage key relationships (e.g., vendors, stakeholders, regulatory bodies) to ensure milestones are achieved and performance objectives are met
- Participates in or coordinates with other department projects as needed
- Assist in development of reporting tools including dashboards, data visualization for use internally and externally
- Provide data support, including designing data collection formats and identifying appropriate sources of data, to the team or their leadership throughout the project and program life cycle, as appropriate
- 3+ years of experience in the healthcare industry
- 2+ years of experience in tracking, planning projects, working with large data sets, and making data-driven analytical decisions
- 2+ years of experience focusing on childhood/adolescent initiatives
- 1+ years of experience with demonstrated functional knowledge of process improvement, quality improvement, and change management
- High level of proficiency with MS Excel
- Moderate level of proficiency with MS Project, PowerPoint and SharePoint
- Experience working with and leading cross-functional teams and projects
- Reside within the Commonwealth of Kentucky
- Travel 25% within the Commonwealth of Kentucky
- Electronic Medical Record, Health Information Exchange experience
- Experience with HEDIS
- Working with Medicare and Medicaid population experience
- Population Health Management experience
- Excellent time management, organizational, and prioritization skills and ability to balance multiple priorities
- Solid analytical and problem-solving skills
- Data visualization tool (eg: Tableau) experience
- Ability to influence and work with internal and external stakeholders/resources to move projects and programs forward and overcome any challenges
- Excellent communication skills both written and verbal
About the Company
UnitedHealth Group
Minnetonka, MN, United States
UnitedHealth Group is a health care and well-being company that’s dedicated to improving the health outcomes of millions worldwide. We are... Read more