Director Medicaid Community Programs - Telecommuter
UnitedHealth Group - Albuquerque, NM

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This position is responsible for the development, deployment and ongoing management of clinical quality programs designed to improve member clinical outcomes. Overall accountable for defining, setting and executing on programs, program goals/outcomes and alignment to QMP and business line goals. Develops, translates and executes strategies or functional/operational objectives and drives programs that impact regional and local markets. Ensures program alignment with State, Federal, and Plan goals and/or regulatory requirements. This position provides research of internal and external program/benchmarks to Plan and quality leadership and provides innovative programs/solutions to improve quality.

Major Responsibilities:
Work Collaboratively with QMP Leadership to define Regional and Health Plan clinical performance targetsResponsible for strategy & tactics to achieve Regional and Health Plan clinical performance targetsResponds to and acts on behalf of the QMP Regional and Health Plan Quality Directors best interest to implement and maintain programs to meet clinical performance targets Regionally and at the Health PlanWork with Program Deployment Team to define program critical success factors and underlying Program Team infrastructure(staffing, process, procedures and performance reporting) Accountable for the consistent application of Standardized Quality Outreach Playbook, which includes deployment and management of proven Regional and Health Plan Programs Accountable for Day to Day operations of program teams, including outreach staffResponsible to coordinate with Program Development and Program Deployment Teams to rollout new programs as needed. Promotes a positive public image, facilitates the establishment of effective and efficient internal and external customer interfaces and ensures development of staff through the implementation of logically developed goals, objectives and strategic plans.Responsible for working collaboratively with internal and external management in the coordination, implementation, and evaluation of quality programs and processes to meet State Requirements.Responsible for development of population profiling and quality modeling used in the development of effective member and provider outreach programs by cost structureResponsible for the identification, development and piloting of New Programs(High, Medium, Low) to achieve to prove assumptions Collaborates with Program Deployment Team, Program Operations Team and Regional & Health Plan QMP Directors, to pilot new programs within Health Plans or populations for effectiveness and ROIResponsible for the ongoing internal & external research on clinical programs, initiatives & for benchmarkingWork Collaboratively with Health Plan, and QMP Leadership to on development, building and deployment of local initiatives Responsible for the design, Collaborate with QMP Program Deployment Team, Program Operations and Regulatory Coordination Team to design Policy & Procedure documentation as well as Trilogy documentation, PIP?sFosters innovative problem solving and upholds principles of continuous quality improvement (CQI).Works with others to develop strategic initiatives in order to meet State and contractual quality requirements Develops annual goals and objectives for the staff in alignment with overall QM & Performance shared service and corporate goals & strategies to meet and exceed established program objectives.Leads and develops staff in areas of personal growth Responsible for guiding development of multiple levels of professional staff while serving as a role model, teacher, coach and leader. Monitors against goals to assess program success and alignment and to identify opportunities for improvement.Ability to understand financial & budget reports and information and maintain neutral budget.Conducts or directs assessments and produces analysis documents to guide strategic planning.Collaborates with internal NQM, heath plans, cross functional departments, as well as staff to identify gaps.Forms internal and external strategic relationships which will support program innovation, and improvement Coaches team regarding policies and procedures, and validate compliance.Communicates departmental and corporate goals and engages everyone in their achievement.Interaction with HP leadership, Community agencies & local health delivery systems and cross departmental functional areas on development, partnership & deployment of innovative regional & local programs.Work with Program Deployment Team to define program critical success factors Collaborates with Program Deployment Team and Regional & Health Plan QMP Directors to deploy new, innovative programs within Health Plans to improve quality outcomes
Responsible for the maintenance of continuous improvement of clinical quality programs such as CPC program, critical incidents, quality of care, etc. Monitors, tracks and trends quality of care and other quality data nationally, regionally and locally to develop quality initiatives in response to variations

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