Director Medicaid Community Programs
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 targets
Responsible for strategy & tactics to achieve Regional and Health Plan clinical performance targets
Responds 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 Plan
Work 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 staff
Responsible 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 structure
Responsible 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 ROI
Responsible for the ongoing internal & external research on clinical programs, initiatives & for benchmarking
Work 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?s
Fosters 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

Requirements

Qualifications:
BA/BS degree in healthcare related field; advanced degree a plus.
6+ years of significant leadership and managerial experience.
5+ years working on program design, development and deployment
5+ years experience in research design & application preferred
Knowledge of CQI principles & practices
Prior experience in statistical analysis and methods a plus
7+ years experience and knowledge of quality, quality improvement, process preferred.
Strong interpersonal skills
Strong verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others.
Proven competency delivering oral presentations.
Proven problem-solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action.
Ability to set strategic direction as well as develop tactical plans and drive performance.

25-40% travel required.

Competencies:
Superior communication abilities with internal and external customers
Strong creative and innovative approaches to problem-solving and programs
Excellent influencing, negotiation and persuasion skills
Empowers and motivates others
Serves as strong coach and fosters career development of others
Excellent leadership skills
Strong business focus with the ability to prioritize, shift priorities and align to divisional and corporate goals and strategies.
Leadership expertise in providing a vision for what has to be done, winning the support to execute the vision and managing to achieve established business objectives.
A leader who can build consensus and a shared perspective from a series of individually focused people and departments.
A builder of trust through strong interpersonal skills, the ability to establish credibility quickly, and a believer in the importance of relationships.
A leader who has vision generates innovation and impacts the future of the regional quality program.
A hands-on natural leader, advisor, and strategist with the demeanor, business maturity, intellect, and integrity required to establish immediate credibility.

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.

You can be a part of this team. You can put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered.

UnitedHealth Group invests in employees through a comprehensive compensation and benefits program, 401(k) savings, retirement and stock plans, education reimbursement, and much more.

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.

UnitedHealth Group - 20 months ago - save job - block
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