Remote w/ Travel – Director Contract STARS Performance Improvement

Job Overview

  • Specialty License RN, ARNP, PA
  • State License(s) Nationwide

This position has responsibilities for Quality Performance Improvement activities for specific contracts across multiple geographies. Serves on multiple Optum Clinical and Quality Committees and leadership teams designed to provide strategic direction for all local care delivery groups within Optum.

 

The Director, Contract Stars Performance Improvement provides strategic direction, leadership and oversight for performance.  This role is responsible for planning, organizing, and directing the administration of all Quality Programs\Strategies. Provides leadership to and is accountable for the performance and direction through multiple layers of management and senior level professional staff. Responsible for coordinating with appropriate personnel to meet operational program needs, ensures compliance with state/federal health plan requirements, Medicare guidelines, NCQA and health plan requirements. Provides long-term planning and oversight to ensure activities are appropriately integrated into strategic direction and operations, as well as the mission and values of the company.

 

You’ll enjoy the flexibility to telecommute* from any location within the Central Time Zone as you take on some tough challenges.

 
Primary Responsibilities:
  • Provides leadership and support in establishing and directing the Stars Program for specific contracts. 
  • Develops and maintains policies and procedures that support the corporate initiatives that meet State, Federal legal requirements and standards.
  • Collaborates with physicians to execute the implementation of the Star initiatives as defined by enterprise and/ Optum LCDO.
  • Provides expertise to the training department on Star measures and tools that support collection of and communication about HEDIS/STAR to the enterprise.
  • Develops HEDIS/STAR member and provider engagement strategies.
  • Collaborates with WellMed executive team to execute HEDIS/STAR strategies
  • Works with Optum LCDO Quality leadership team to provide HEDIS/STAR reporting and to develop strategic direction.
  • Facilitates, integrates, and/or coordinates the implementation and evaluation of identified CAHPS/HOS/quality improvement/HEDIS/STAR activities as requested by UHG/UHC or related companies.
  • Promotes understanding, communication and coordination of all quality improvement program components.
  • Participates in requested evaluations and audits for UHC and other health plans.
  • Coordinates reporting on quality initiatives to all appropriate committees.
  • Participates in various teams, committees and meetings at any level required to maintain business necessity.
  • Maintains Star program documents, reports, and committee minutes and follows all internal privacy and confidentiality policies and procedures.
  • Oversees the CAHPS/HOS survey process for all contracted health plans.
  • Leads the coordination and completion of projects with cross-functional teams and senior leaders across medical/nursing/clinical functional areas to achieve targeted clinical strategic performance goals.
  • Oversees medical/nursing/clinical workflow mapping, performance monitoring, and coaching site visits in clinic settings using process improvement methodologies to identify workflow gaps and establish future-state recommendations.
  • Directs medical/nursing/clinical best practice identification and standardization adoption in clinical settings with cross-functional teams and senior leaders.
  • Directs and promotes clinical support for clinic staff and nursing roles (RN/LVN Health Coach) with subject matter expertise and resources for population management, nurse advocacy and development opportunities, and nurse coaching/feedback programs.
 

The pace is fast and you’ll need to be comfortable managing multiple priorities. You may be required to work in multiple locations, so scheduling flexibility is essential. You must also be able to respond calmly and effectively in emergency situations.

 

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.

 

This role has the opportunity to telecommute within the Central Time Zone.

 

Required Qualifications:
  • BA/BS degree in healthcare related field; clinical background (Registered Nurse or Nurse Practitioner).  
  • 6+ years of management-level experience in managed care Quality programs, including 5+ years of experience at the Director level or above.
  • Demonstrate knowledge of the business environment and business requirements (e.g., strategy changes, emerging business needs)
  • Knowledge of CAHPS, HOS, NCQA HEDIS requirements and CMS STAR requirements
  • Ability to establish and maintain effective working relationships with employees, managers, healthcare professionals, physicians and other members of senior administration and the general public.
  • Excellent verbal, written communication, presentation, and facilitation skills.
  • Knowledge of fiscal management and human resource management techniques.
  • Ability and willingness to travel both locally and non-locally as determined by business need.

Careers with WellMed. Our focus is simple. We’re innovators in preventative health care, striving to change the face of health care for seniors. We’re impacting 380,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We’ve joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life’s best work.(sm)

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

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.