Director of Clinical Quality-Americhoice - (US-MS-Jackson - 39298)

Minimum Education: None
Jobcode: 60022869
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UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health.

AmeriChoice 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.
 
If you're ready to help make health care work better for more people, you can make a historic impact on the future of health care at AmeriChoice.
 
We contract with states and other government agencies to provide care for over two million individuals. Working with physicians and other care providers, we ensure that our members obtain the care they need with a coordinated approach.
 
This enables us to break down barriers, which makes health care easier for our customers to manage. That takes a lot of time. It takes a lot of good ideas. Most of all - it takes an entire team of talent. Individuals with the tenacity and the dedication to make things work better for millions of people all over our country.
 
Positions in this function include those responsible for a variety of functions in areas such clinical quality program implementation throughout the Assigned Health Plan that includes but is not limited to improvement, monitoring and assessment; HEDIS improvements; NCQA accreditation; quality regulatory compliance
care/service issues resolution.
 
 Provides leadership to and is accountable for the performance of plan based managers and/or senior level  professional staff

• Manages all Quality improvement functions for assigned health plan
  


• Increases national Quality initiatives to improve member care and meet state regulatory requirements for Q1 projects (PIPs)
  


• Oversight of HEDIS RN's and other Plan Quality staff
  


• Provides direction and guidance on clinical quality improvement and management programs including accreditation,  regulatory requirements and the HEDIS Nurse program. 
  


• Conducts clinical quality audits and may also be responsible for NCQA requirements.
  


• Responsible for the reporting and analysis of member care quality, provider and member satisfaction, access and availability, provider credentialing, and for the development of plans and programs to support continuous quality improvement using HEDIS and other tools.
  


• Supports national quality activities such as the physician profiling/P4P program and the Appeal & Grievance Unit QOC/S resolution as needed.
  


• Responsible for implementation and approval of the QI Program and Workplan as well as the development and approval of the annual QI Program Evaluation.
  


• Facilitates health plan committees such as the Quality Management Committee and the Provider Affairs Subcommittee and participates as appropriate on national quality meetings.
  


• Oversees P4P Program
  

•    Clinical Registered Nurse with current licensure preferred or eqivalent healthcare quality leadershipexperience.


•    Bachelors degree in Science or Business required; Masters degree preferred


•    8+ years clinical practice experience


•    4+ years working in managed care quality department experience required


•    Proven success managing, implementing and auditing clinical quality programs


•    4+ years demonstrated leadership and team development skills


•    Ability to set strategic direction as well as develop tactical plans and drive performance


•    Excellent written and verbal communications skills


•    Microsoft software proficient


•    Strong interpersonal skills


•    Certified Professional in Healthcare Quality (CPHQ) certification preferred