Manager Quality Operations - Dallas Fort Worth, TX

Decker Jones, P.C.; Irving (TX); On-site; USD 71,000 - 141,000; Full time

Job summary

Join a leading healthcare company as a Quality Manager, where you'll drive quality initiatives and manage teams to achieve high HEDIS/Star ratings. This role involves strategic planning, performance management, and collaboration across departments to enhance patient care delivery for seniors. Enjoy a supportive work environment and opportunities for professional growth, along with a competitive salary and comprehensive benefits.

Benefits

Comprehensive benefits packages

Incentive programs

Stock purchase options

401k contributions

Qualifications

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

Responsibilities

• Manage Quality Coordinators and Clinical Quality Consultants.
• Oversee staff development and ensure quality service.
• Analyze data and collaborate with stakeholders.

Skills

Analytical skills

Data visualization skills

Communication

Leadership

Tools

Microsoft 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 understanding and supporting the vision to change healthcare delivery for seniors. This role will drive the financial viability of the market HEDIS/Star program and provide comprehensive quality care for members. Responsibilities include strategic planning, analysis, understanding of HEDIS and coding, team management, communication, and process development, especially in ambiguous situations with interdependencies. The position also involves resolving issues from standard processes.

Primary Responsibilities:

1. Manage Quality Coordinators, Clinical Quality Consultants, and Senior CQC staff to ensure success of the market’s HEDIS/Star results for contracted physicians.
2. Oversee staff development, including hiring, training, coaching, and growth.
3. Maximize staff performance and expertise through clear objectives, training, and leadership to ensure quality service.
4. Delegate, monitor, and control work progress on key metrics, initiatives, staff productivity, and expenses.
5. Participate in developing and implementing systems and processes supporting quality operations.
6. Maintain effective cross-functional services by collaborating with Medical Directors, Market Operations, Regional Teams, and other departments.
7. Handle complex provider inquiries and issues, facilitating resolutions while maintaining positive relationships.
8. Take ownership of work processes and provide constructive feedback to support physician partners.
9. Analyze data and collaborate with colleagues to identify root causes of issues.
10. Understand providers’ goals to facilitate issue resolution.
11. Work with internal stakeholders to identify obstacles and develop solutions to meet HEDIS/Star goals.
12. Communicate industry and company information to providers via various channels.
13. Develop and coach staff for strategic meetings with physician groups.
14. Ensure staff competency and provide input on educational tools.
15. Respond to market operation and provider inquiries effectively.
16. Facilitate provider discussions, negotiate resolutions, and escalate issues when necessary.
17. Collaborate with leadership to eliminate duplication and member/provider abrasion.
18. Travel up to 25% locally.
19. Perform other related duties as assigned.

We offer a challenging environment with clear success pathways and development opportunities.

Required Qualifications:

• 5+ years of experience in Quality/HEDIS/CMS Stars.
• 2+ years supervisory experience, including SME or Team Lead roles.
• Strong knowledge of Medicare quality operations, HEDIS, Stars, Coding, and Medicare Advantage.
• Knowledge of state and federal Medicare laws.
• Advanced Microsoft Office skills, especially Excel.
• Exceptional analytical and data visualization skills.
• Ability to travel locally up to 25%.
• Valid driver’s license and reliable transportation.

Preferred Qualifications:

• Project Management experience.
• Provider Relations experience.
• ICD10, CPT, CPT II coding knowledge.
• Financial analytical background in Medicare Advantage (Risk Adjustment/STARS).

The salary range is $71,600 to $140,600 annually, based on full-time employment and various factors. Benefits include comprehensive packages, incentive programs, stock purchase options, and 401k contributions. We are committed to diversity, equity, and inclusion, and to providing equitable care and addressing health disparities.

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