Status: Full-time position
Location: Albuquerque, NM
Job Summary: UnitedHealthcare Community & State is currently seeking a Senior Director, Clinical Quality to work in our Albuquerque, NM office.
The SeniorDirector, Clinical Quality is the primary health plan leader accountable for establishing and implementing an effective quality improvement program essential to meet NCQA and requirements of the state of New Mexico.
Qualifications: Bachelors Degree in Nursing and/or Bachelors Degree in Public Health, Business or related field.
A minimum of 5 years of progressive experience in Quality Improvement within healthcare industry.
Demonstrated previous success implementing effective HEDIS programs and NCQA accreditation.
Experience managing and coordinating regulatory audits including documentation, onsite preparation, and responsive corrective action plans.
Demonstrated excellent leadership/management/supervisory experience.
Prior experience and familiarity with audit processes of External Quality Review Organizations (EQRO).
Previous experience working as an executive-level health plan quality leader strongly preferred.
Prior experience and understanding of New Mexico Value-Based Purchasing program preferred.
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
Duties: Serving as primary liaison with UHC Community National Quality Team, effectively leveraging and coordinating national quality team resources and initiatives with local health plan quality resources, initiatives and requirements.
Providing primary oversight for quality initiatives that meet New Mexico contractual requirements. Responsible for NCQA readiness, accreditation, and ongoing compliance with NCQA requirements. Providing effective leadership and management oversight of direct reports and members of the quality team. Developing and implementing programs and processes to achieve HEDIS and state value-based purchasing program requirements. Establishing and implementing initiatives to achieve maximum results from CAHPS and state provider satisfaction survey initiatives. Establishing and implementing governance and oversight of health plan quality program, including coordination of committee structure described in the health plan quality improvement program. Serve as primary driver of Performance. Improvement within the health plan, including committee oversight, work plans and annual evaluation.
Other locations include
Las Cruces, NM and Santa Fe, NM
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.
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
Apply online at the following link