For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm) This position works with WyHealth Medicaid WY program and is responsible for quality metrics of the program. This position is a key stakeholder in the success of the overall program and is considered a part of the leadership team in Wyoming. The Quality Manager Lead achieves success by ensuring all functions of the WY State WyHealth program are performed in the essence and structure of a QIO-Like entity. This position will report daily to the local WY office. Candidates must reside in the state of Wyoming. Primary Responsibilities:Collect, Analyze, and Investigate Quality Data and/or Information:Collect Quality data and / or information based on applicable standards, state / federal or other regulations, customer or consumer requests, internal requests, or project assignmentsIdentify appropriate sources for data or information either internally or externally and collect data / informationDevelop effective methods for data/information collectionIdentify appropriate data platform or application (e.g., data bases, Intranet source, Internet source) and utilize to collect data or informationInvestigate Quality problems identified and collect additional information to close gapsWork cross functionally and coordinate with others internally or externally to gather information; overcome challenges to obtaining needed informationMine data and / or information to identify inconsistencies, trends, other information needed, etc. (e.g., develop and/or run data queries)Analyze and interpret data or information (e.g., clinical, administrative, Quality) to ensure they meet standards, are compliant and / or are accurate and completeProvide explanations or updates when data / information (e.g., clinical, administrative) are not accurate or unclearExplain the characteristics of the data / information (e.g., clinical, administrative) including any unique attributesIdentify Quality improvement or intervention opportunities and work cross - functionally to develop interventions or recommendations.Document and Report Quality Information:Develop or update work plans (e.g., annual work plan)Develop or update program descriptions (e.g., annual program descriptions)Develop program evaluations (e.g., annual program evaluation)Develop, update, and/or review policies and proceduresReview results, conduct analyses (e.g., evaluate against goals / effectiveness of interventions over time), and prepare reports on findingsFollow regulations and internal or external protocols for communicating information or dataUtilize computer systems to identify and annotate informationLoad completed information into relevant systems according to specificationsDevelop an understanding of the intended audience and determine the best method to communicate data or informationCommunicate Quality data or information in writing or verballyReport results (e.g., quality improvement initiatives, audits) to committees, Board of Directors, external stakeholders, regulatory agencies, etc. and respond to questions or solicit feedback and inputPerform / Participate in Audits or Review Activities to Ensure Quality:Develop understanding of customer requirements and / or expectations and anticipate needs to determine appropriate course of actionDevelop audit or review processes (e.g., automated / technically driven)Review relevant agreements (e.g., contractual, intersegment) and obtain clarification as necessaryRead and interpret standards / requirements and/or technical specifications (e.g., structure and process, CMS star ratings , URAC, NCQA / HEDIS / CAHPS / member satisfaction specifications, SNP)Evaluate current processes, compare to relevant standards or specifications and identify gaps in compliance or performancePerform / participate in assessments of the audit or review (e.g., interrater reliability of audit findings across auditors)Work cross - functionally, making recommendations or clarifying information to assist in closing gaps that are identified or meeting customer expectationsWork with auditors or key stakeholders for review / approval of resultsDevelop and / or assist with corrective action plans based on audit findings or customer feedbackReview processes and performance against customer expectations to provide needed information or serviceManage Quality Projects or Work Objectives:Define project scope and develop project planIdentify and recruit appropriate staff to assist with projects as necessaryCoordinate with others to set appropriate deadlines when necessaryCollaborate with stakeholders for review, input, and / or approval at key milestonesManage key relationships (e.g., vendors, stakeholders, regulatory bodies) to ensure milestones are achieved and performance objectives are metManage or actively participate in meetings (e.g., schedule, present, document meeting results, facilitate)Provide information and feedback to project team with respect to achievement of objectivesLeverage clinical expertise to inform decision - making and program developmentTrack timeframes / deadlines and collect data or information within required timeframesIdentify, prioritize, and proactively communicate potential barriers or risks to key stakeholdersProvide Quality Information, Education or Training to Others:Educate, motivate, and / or influence others (e.g., leadership, other stakeholders, including those for whom there is no direct line of authority) to understand the overall scope, overcome potential barriers, and engage in and commit to the processCommunicate and explain applicable standards (e.g., industry/performance) and /or technical specifications and identified gaps and / or changes in applicable standardsDevelop educational materials (e.g., member, provider and / or staff materials)Work with others to ensure messaging to members and / or providers is appropriate to the audience, complete / accurate, and compliant (e.g., with external / internal regulations and protocols)Train others on relevant policies, rules, or regulations (e.g., appropriate release of data, handling protected health information)Serve as a resource providing explanations and expertise (e.g., accreditation, providing information to othersServe as a key member of WY Wyhealth Leadership team and active member of the Optum Executive Quality, QIO - Like Committee, and serves as the key point person for the WDH in quality performance issues with the program
Required Qualifications:Bachelor's degree or higherMinimum 5+ years of experience in healthcare quality operations to include administrative type roles, management, leadership and analytical reviews.2+ years of customer facing experience.2+ years professional experience in quality positionProfessional experience using data analytics Proficient in Microsoft Word, PowerPoint, Excel and Office Reside in the state of Wyoming strongly preferredPreferred Qualifications:Graduate coursework in business or health care administration 2+ years Medicaid managed care / care management experience Basic familiarity with CMS QIO - Like requirements and expectationsLeadership presence. Embraces and exemplifies Optums core values Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity 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: Manager, Supervisor, Health Care, Operations, Clinical Operations, Medical Operations
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.