Manager Quality Operations - Dallas Fort Worth, TX

Bastion Law, PLLC; Irving (TX); On-site; USD 71,000 - 141,000; Full time

Job summary

A leading healthcare company seeks a Quality Manager to enhance healthcare delivery quality for seniors. The role encompasses managing HEDIS/Star metrics, coordinating staff, and driving initiatives supporting quality care. Successful candidates will demonstrate significant experience in Medicare operations and supervisory roles.

Benefits

Comprehensive benefits package

Equity stock purchase

401k contributions

Qualifications

• 5+ years of related experience in Quality/HEDIS/CMS Stars.
• 2+ years supervisory experience.
• Solid knowledge of Medicare quality operations.

Responsibilities

• Manage Quality Coordinators and be responsible for HEDIS/Star results.
• Oversee staff development including hiring and training.
• Analyze data and facilitate issue resolutions.

Skills

Analytical skills

Leadership

Communication

Project Management

Tools

Microsoft Office

Excel

Job description

Opportunities at WellMed, part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinical staff, and non-patient-facing roles, you can make a difference with us as you discover the meaning behind Caring. Connecting. Growing together.

The Quality Manager is responsible for driving consistency in program implementation designed to facilitate a minimum of a 4 Star quality rating. These initiatives should result in the contracted network being able to understand and support the vision to change the face of healthcare delivery for seniors. This will drive the financial viability of the market HEDIS/Star program and provide a full quality of care for the members. The responsibilities of this position demand a wide range of capabilities including: strategic planning and analysis skills; solid understanding of HEDIS and coding; management breadth to direct and motivate; highly developed communication skills; and the ability to develop clear action plans and drive process, given often ambiguous issues with numerous interdependencies. This position will facilitate any unresolved issues that remain as a result from following the standard process.

Primary Responsibilities:

1. Manage Quality Coordinators, Clinical Quality Consultants (CQC) I, II, and Senior CQC and be responsible for the overall success of the market's HEDIS/Star results for contracted physicians.
2. Responsible for all aspects of staff development including hiring, training, coaching, and development.
3. Maximize staff performance and technical expertise through clearly defined objectives, training, skill development, and leadership to ensure quality services to all customers.
4. Delegate, monitor, and control work progress on key HEDIS/Star metrics, initiatives/action plans, staff productivity, and administrative expenses.
5. Participate in the development and implementation of systems and processes that support quality operations.
6. Maintain effective cross-functional services by working effectively with the Medical Director, Market Medical Director, Market Operations, Regional Team, Clinic Operations, and other corporate departments.
7. Handle complex and/or difficult provider inquiries and problems, facilitating resolution of provider issues while maintaining favorable relationships and ensuring organizational interests.
8. Take ownership of the total work process and provide constructive information to support physician partners in meeting initiatives.
9. Analyze data collaboratively with colleagues and business partners to identify potential root causes of issues.
10. Understand providers' goals and strategies to facilitate issue resolution.
11. Work with internal stakeholders to identify obstacles and barriers faced by providers, and methods for removing them.
12. Communicate and advocate providers' needs to internal stakeholders to drive solutions that meet HEDIS/Star goals.
13. Communicate industry and company information to providers through various means such as newsletters, emails, outreach calls, teleconferences, conferences, and on-site meetings.
14. Develop and coach staff to facilitate strategic meetings with physician groups and their staff.
15. Oversee and ensure competency of the Quality market staff.
16. Assist corporate and local education teams and provide input on tools used for education of quality staff and provider support staff.
17. Ensure all education objectives are met, both formally and informally.
18. Respond to market operations and provider inquiries effectively.
19. Facilitate provider discussions and assist in resolving escalated issues, determining when escalation is necessary.
20. Work with cross-functional leadership to eliminate duplication and member or provider abrasion.
21. Travel up to 25% locally as needed.
22. Perform all other duties as assigned.

We offer a rewarding environment that challenges you, provides clear success criteria, and opportunities for growth in other roles.

Required Qualifications:

1. 5+ years of related experience in Quality/HEDIS/CMS Stars.
2. 2+ years supervisory experience, including SME or Team Lead roles.
3. Solid knowledge of Medicare quality operations including HEDIS, Stars, Coding, and Medicare Advantage.
4. Knowledge of state and federal laws relating to Medicare.
5. Advanced Microsoft Office skills, proficient in Excel.
6. Exceptional analytical and data representation skills.
7. Ability to travel locally up to 25%.
8. Driver's License and access to reliable transportation.

Preferred Qualifications:

1. Project Management experience.
2. Provider Relations experience.
3. ICD10/CPT/CPT II coding knowledge.
4. Financial analytical background within Medicare Advantage plans (Risk Adjustment/STARS Calculation models).

The salary range for this role is $71,600 to $140,600 annually, based on full-time employment and various factors. Benefits include comprehensive packages, incentive and recognition programs, equity stock purchase, and 401k contributions. We are committed to diversity, equity, and inclusion, and to mitigating our environmental impact.

UnitedHealth Group is an Equal Employment Opportunity employer and a drug-free workplace. Candidates must pass a drug test before employment.