Manager Quality Operations - Dallas Fort Worth, TX

Austin Bar Assocation; Irving (TX); On-site; USD 71,000 - 141,000; Full time

Job summary

A leading healthcare provider seeks a Quality Manager responsible for enhancing healthcare delivery for seniors through quality initiatives. The successful candidate will manage a team focused on HEDIS/Star program success, ensuring comprehensive quality care for members. This role includes strategic planning, staff development, and collaboration with multiple stakeholders, highlighting the importance of impactful leadership in healthcare.

Benefits

Comprehensive benefits package

Incentive programs

Equity stock purchase

401k contributions

Qualifications

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

Responsibilities

• Manage Quality Coordinators and ensure success in HEDIS/Star results.
• Develop action plans for quality services.
• Communicate provider needs to internal stakeholders.

Skills

Analytical skills

Data representation skills

Microsoft Office

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 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. Manages Quality Coordinators, Clinical Quality Consultants (CQC) I, II, and Senior CQC and is 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. Maximizes staff performance and technical expertise through clearly defined objectives, training, skill development, and leadership to ensure quality services to all customers.
4. Delegates, monitors, and controls work progress on key HEDIS/Star metrics, initiatives/action plans, staff productivity, and administrative expenses.
5. Participates in the development and implementation of systems and processes that support quality operations.
6. Maintains 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. Handles complex and/or difficult provider inquiries and problems, facilitating resolution while maintaining favorable relationships.
8. Takes ownership of the total work process and provides constructive information to support physicians in meeting initiatives.
9. Analyzes data collaboratively to identify root causes of issues.
10. Understands providers' goals and strategies to facilitate issue resolution.
11. Works with internal stakeholders to identify obstacles and remove barriers for providers.
12. Communicates providers' needs to internal stakeholders to drive solutions that meet HEDIS/Star goals.
13. Communicates industry and company information to providers via newsletters, emails, calls, teleconferences, conferences, and on-site meetings.
14. Develops and coaches staff for strategic meetings with physician groups.
15. Ensures competency of the quality market staff and supports education initiatives.
16. Facilitates provider discussions and escalates issues as necessary.
17. Collaborates with cross-functional leadership to eliminate duplication and member/provider abrasion.
18. Includes up to 25% local travel.
19. Performs other duties as assigned.

You'll be rewarded and recognized for your performance in an environment that challenges you, provides clear success criteria, and offers development opportunities.

Required Qualifications:

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

Preferred Qualifications:

• Project Management experience
• Provider Relations experience
• ICD10/CPT/CPT II coding knowledge
• 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 including experience and location. Benefits include comprehensive packages, incentive programs, equity stock purchase, and 401k contributions.

Our mission is to help people live healthier lives and improve the health system for everyone. We are committed to equity, environmental responsibility, and addressing health disparities. UnitedHealth Group is an Equal Employment Opportunity employer and a drug-free workplace, requiring a drug test before employment.