Diretor Health Plan Clinical Quality, Medicaid
UnitedHealth Group 3,718 reviews - Omaha, NE

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The Director of Clinical Quality, Community & State, is primarily responsible for organizational development and planning of an integrated multi-disciplinary quality improvement structure that will effectively monitor support and lead quality improvement initiatives. This individual must exhibit the necessary leadership and management skills as well as the ability to utilize both internal and external resources to accomplish the goals and objectives of the Quality Improvement Plan (QIP) in support of government programs. Positions in this function include those responsible for supporting a variety of functions in areas such as clinical quality program implementation, improvement, monitoring and assessment; HEDIS improvements; NCQA accreditation; quality regulatory compliance; and oversight of quality of care issues resolution. Also responsible for identified processes in clinical quality improvement and management programs including accreditation and regulatory requirements.


Establish and maintain a Quality Improvement program that encompasses all NCQA requirements and government programs

Develop and implement training programs designed to improve the performance of government programs with state and federal regulatory requirements and business plan

Prioritize areas of business risk and incorporate into the strategy of the quality improvement plan

Coordinate quality efforts between Shared Services and other United segments to leverage strengths and ensure a collaborative approach to achieving efficiencies in improving outcomes

Develop, coordinate and lead corporate quality committees operational standards and P&Ps to meet the objectives of a government program QIP

Identify opportunities and best practices to standardize processes to improve efficiencies and health outcomes across all government programs

Support implementation of CMS and State required clinical Quality Activities for Performance Improvement (QAPI) pertinent to all government programs

Evaluate the effectiveness of the Quality Program by organizing the delivery and evaluation of annual customer satisfaction surveys for government programs

Monitor and respond to regulatory changes related to quality

Recommend opportunities for performance improvement of government programs through the tracking and trending of aggregate data related to quality and performance metrics (HEDIS scorecards report cards and dashboards)

Requirements Qualifications:

Bachelor’s degree in sciences health-related field or business management essential (clinical related degree preferred, others may be considered upon experience).

Managed Medicaid Health Plan experience required

Dual Special Needs Population experience preferred

Experience with URAC and NCQA required

Certified Professional in Healthcare Quality (CPHQ) preferred

Knowledge of CMS as well as numerous State Medicaid requirements

Experience in preparing for and leading accreditation surveys

Demonstrated project management experience required

Excellent communication skills and ability to drive results in a highly matrixed organization.

UnitedHealthcare, part of the UnitedHealth Group family of companies, is comprised of three specialized businesses dedicated to meeting the health care benefits needs of individuals and groups; all part of something greater, but each with a specialized focus:

UnitedHealthcare Employer & Individual works with individuals, small businesses and large multi-site employers to provide innovative, affordable benefits services.

UnitedHealthcare Medicare & Retirement is focused on serving Americans over the age of 50. It is the largest business dedicated to meeting the growing health and well-being needs of aging individuals in the nation, serving one in five Medicare beneficiaries through a comprehensive and diversified array of products and services through four industry-leading businesses.

UnitedHealthcare Community & State provides high-quality, personalized, public-sector health care programs that help local government agencies improve health outcomes for millions of children and low-income and disabled individuals at an affordable cost.

Together, we’re removing the barriers that keep people from receiving the kind of quality health care that makes a difference. We focus on Integrity, Compassion, Relationships, Innovation and Performance as we empower people to achieve better health and well-being.

Come grow and thrive in our culture of innovation and ideas. Because there is no opportunity greater than the quest to help people live healthier lives.

UnitedHealthcare Medicare & Retirement is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.

Imagine joining a group of professionals and clinicians who are working to improve health care for people over 50. Consider the influence you can have on the quality of care for millions of people. Now, enhance that success with enthusiasm you can really feel.

That's how it is at UnitedHealthcare Medicare & Retirement. Every day, we're collaborating to improve the health and well-being of the fastest growing segment of our nation's population. And we're doing it with an intense amount of dedication.

Here, you will discover a culture that grows through challenge. That evolves by being flexible. That succeeds by staying true to our mission to make health care work effectively and efficiently for seniors. Put your best to work for us, and discover extraordinary opportunities for growth.

Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V

UnitedHealth Group is a drug-free workplace.

Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.

About this company
3,718 reviews
UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier...