Associate Director, Stars and Quality - Western/Central States - Remote

UnitedHealth Group; Phoenix (AZ); Remote; USD 113,000 - 193,000; Full time

Benefits offered by this job

Comprehensive benefits package

Equity stock purchase plan

401(k) contribution

Job summary

UnitedHealth Group is seeking an Associate Director of Stars and Quality to guide strategy for H-contracts across states and ensure 4+ star performance. You will coordinate with Quality Field Org, ACOs, and national teams to optimize HEDIS and CMS measures while leveraging data insights and cross-functional collaboration.

Remote work is supported for Western/Central States with in-office requirements in certain markets.

Qualifications

• 5+ years in a large health care/managed care organization.
• 3+ years with health care providers, CMS Star ratings, and HEDIS measures.
• Willing to travel 30%+ depending on business need.

Responsibilities

• Devise, communicate, monitor and drive the H-contract path to 4+ stars, coordinating with Quality Field Organization, ACO teams, M&R leadership to ensure 4+ star performance.
• Mine data to identify opportunities for performance improvement in Stars, HEDIS, operations, and CAHPS/HOS measures across markets.
• Collaborate with MEGA contracts owner team, National STARS and HEDIS owners, and West Region to develop contract/market strategies and partner with vendors for measure closure.
• Create a year-round HEDIS chase strategy focusing on spring collection and abstraction best practices.
• Coordinate with Medicare & Retirement national functions and Optum to drive local tactical plans for CMS Star improvement.
• Coordinate with Network, ACO Team, QFO, and Optum Care to provide direction for Performance Managers and tools, ensuring performance targets are met.
• Partner with Network and Medical leadership to increase HouseCalls completion and reduce refusals.
• Meet all assigned performance targets and maintain strong cross-functional relationships.
• Model UnitedHealth Group values and culture in daily work.
• Other duties as assigned.

Skills

Healthcare experience

CMS Star ratings

HEDIS measures

Data analysis

Travel availability

Job description

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 optimized. Ready to make a difference? Join us in making healthcare work better for everyone through people-led, responsible AI whileCaring. Connecting. Growing together.

Associate Director of Stars and Quality, Multi-State Contracts is accountable for both defining the strategy for getting UHC H-Contracts to 4+ Star performance on all membership within those plans and ensuring the strategy is carried out. These contracts cross states, markets and in some cases market CEOs; therefore the Associate Director of Stars and Quality must ensure all stakeholders are coordinating to drive high quality performance.

If you are located in Western/Central States, you will have the flexibility to work remotely* as you take on some tough challenges

For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.

Primary Responsibilities

• Devise, communicate, monitor and intimately understand the H-contract path to 4+ stars and coordinate with the Quality Field Organization, Accountable Care Organization Team, Optum Care, and M&R leadership on all activities that ensure 4+ star performances
• Be considered the center of the data strategy; meaning constantly be mining data to find all opportunities for performance improvement in all aspects of Stars performance including HEDIS Part C and D, operations (e.g., disenrollment, appeals etc.), CAHPS/HOS market level detail from various sources such as KPI, CAHPS/HOS surveys, offseason CAHPS/HOS surveys etc.
• Collaborate with the MEGA contracts owner team, National STARs and HEDIS measure owners, and the West Region team to develop contract and market strategies, discuss best practices, and look for opportunities to partner with vendors to support measure closure
• Create a year round HEDIS chase strategy with particular focus on spring collection and abstraction best practices; driving best in class rate max activities in coordination with HEDIS Ops, ACO, and QFO
• Actively coordinate with all Medicare & Retirement national functions (Product, Sales, Marketing, Member Experience, Finance), UnitedHealthcare shared services functions (Network, Clinical, Quality, Operations), Optum (Local Care Delivery, HouseCalls, Complex Population Management), lines of business (M&R, DSNP, ISNP, Group) and local leadership (Local EDs, CEOs) to leverage local market knowledge and establish and drive local tactical plans for improving CMS Star ratings and quality for assigned H-Contracts
• Coordinate with Network, ACO Team, QFO, and Optum Care teams to provide Practice Performance Managers, Clinical Transformation Managers, and embedded Practice Resources strategic direction; approve performance targets / metrics; ensure performance to targets. Includes positive physician HEDIS run-rate performance; development and use of appropriate supporting tools (HouseCalls, CAHPS/HOS tools, documentation training)
• Partner with Network, Market Medical Director, QFO, ACO, and Optum to increase HouseCalls completion rates and reduce refusal rates
• Meet all assigned performance targets
• Maintain strong relationships with Medicare & Retirement national functions, UnitedHealthcare shared services functions and Optum businesses through regular communications and face to face contacts
• Exemplify and model Our United Culture and live our values with conviction
• Other duties, as assigned
  

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.

Required Qualifications

• 5+ years of experience in a large, complex and successful health care / managed care organization with demonstrated track record of increasing responsibility and accountability
• 3+ years of in-depth experience with health care providers / networks, CMS Star ratings, HEDIS measures and clinical quality
• Willing and able to travel 30% + depending on business need

Preferred Qualifications

• RN
• Experience in a Medicare Advantage business
• Solid written and verbal communication skills, including well-developed interpersonal skills used to influence the behavior of others across a highly-matrixed organization
• Demonstrated success building relationships with external executives and stakeholders
• Track record of meeting business goals via driving disciplined, fact-based decisions and executing with discipline and urgency
• Demonstrated solid financial / analytical skills

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $112,700 - $193,200 annually based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and help make the health system work better for everyone. Together, we are shaping the future of healthcare by harnessing technology and innovation to make care simpler to navigate, more affordable and more connected for the people we serve. We are committed to creating an inclusive workplace where everyone feels welcomed, valued, heard and respected, empowering people to bring their authentic selves to work and strengthening our collective impact through diverse talents, backgrounds, experiences and perspectives.

UnitedHealth Group and its affiliated brands are an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group and its affiliated brands are a drug-free workplace. Candidatesare required topass a drug test before beginning employment.