Quality Specialist Job in Multiple locations

UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health.

AmeriChoice is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.

If you're ready to help make health care work better for more people, you can make a historic impact on the future of health care at AmeriChoice.

We contract with states and other government agencies to provide care for over two million individuals. Working with physicians and other care providers, we ensure that our members obtain the care they need with a coordinated approach.

This enables us to break down barriers, which makes health care easier for our customers to manage. That takes a lot of time. It takes a lot of good ideas. Most of all - it takes an entire team of talent. Individuals with the tenacity and the dedication to make things work better for millions of people all over our country.

The major responsibility of this Medicaid position is to effectively monitor and support organization-wide quality improvement initiatives, with particular emphasis on compliance with state and federal regulatory and accreditation requirements. The position supports the Connecticut and Rhode Island Quality Improvement Programs by working with the plans' (Associate) Director of Quality Improvement and Medical Directors to design and implement initiatives aimed at improving clinical care and service for members, service to providers, and operational processes impacting internal / external stakeholders.

Provides leadership and guidance on quality improvement studies, including but not limited to state-required QIPs and /or other activities aimed at improving the services rendered to members and health plan operations.

Manages the health plans' cross-functional Service Quality Improvement Committees (SQIS), a subcommittee of the plans' Quality Management Committees which oversee the quality improvement program and each plan's accreditation status.

Responsible for using data to drive activities aimed at improving members' and provider's satisfaction, including but not limited to the annual CAHPS survey, annual provider satisfaction survey, and annual case management satisfaction surveys, inclusive of measuring effectiveness

Works with the plans' (Associate) Director of Quality Improvement and Medical Directors to identify and develop service and satisfaction measures of effectiveness; monitors performance and works to improve and support continuous quality improvement using survey and other data.

Project manages the NCQA accreditation readiness review and submission processes, including but not limited to submission of the NCQA application, ownership of the ISS submission tool, regular monitoring and dissemination of updated accreditation requirements to affected stakeholders; and development and oversight of post-accreditation improvement plans.

Participates in the collection, organization, analysis, identification of improvement opportunities and reporting of data to evaluate and support activities related to accessibility of services including network availability, appointment availability, after hours accessibility, and culturally and linguistically appropriate services (CLAS).

Drives the development of / maintains health plan policies and procedures that fulfill regulatory and accreditation expectations.

Participates and / or leads process improvement initiatives and projects to enhance operational efficiency for members, providers, and/or staff.

Act as the health plan's representative and liaison in state-wide initiatives aimed at improving health care services and care for members.

Supports member outreach programs through the use of the health plan's Universal Tracking Database (UTD).

Collaborates with external community partners, including but not limited to the Department of Health and the Department of Human / Social Services.

You can be a part of this team. You can put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered.

Willingness to travel on occasion (20%) between two health plan locations (RI and CT)

Knowledge of HEDIS standards and procedures and/or experience using HEDIS data to monitor quality of care and support performance improvement

Working knowledge of NCQA, CAHPS, and / or URAC preferred

Bachelor's degree from a four year college or university

Current RN, unrestricted license to practice (preferred but not required)

Three or more years experience in a managed care organization or health care organization

Experience in managing quality improvement projects

Demonstrated project management experience and skills

Proficient computer skills with MS office

Strong interpersonal skills; experience with member or provider outreach

Strong communication skills both verbal and written

Strong ability to foster an environment of learning and empowerment

Quantitative and analytic capacity

Ability to manage multiple priorities

Ability to work across departments (matrix structure) as a part of a multi-disciplinary team

Ability to collaborate effectively with physicians and other health care professionals

Knowledge of State and Federal Health Care regulations

Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.

Additional Information:

Travel Percentage: 25%

Additional Information:

HIDE