Clinical Quality Call Center Senior Manager

Careers at UnitedHealth Group

We're creating opportunities in every corner of the health care marketplace to improve lives while we're building careers. At UnitedHealth Group, we support you with the latest tools, advanced training and the combined strength of high caliber co-workers who share your passion, your energy and your commitment to quality. Join us and start doing your life's best work. SM

Clinical

Compassion. It's the starting point for health care providers like you and it's what drives us every day as we put our exceptional skills together with a real feeling of caring for others. This is a place where your impact goes beyond providing care one patient at a time. Because here, every day, you're also providing leadership and contributing in ways that can affect millions for years to come. Ready for a new path? Learn more, and start doing your life's best work. SM

Our teams are helping people from around the world. We can bring out your best as you put your listening, analytical and problem solving skills to work in a setting that is geared to helping improve lives and enhance health care for millions. Here, you'll discover a wealth of pathways for professional growth within Customer Service, Billing, Claims, Enrollment & Eligibility and across our global economy. Join us and find out why this is the place to do your life's best work. SM

Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life's best work.(sm)

The WellMed Quality Clinical Operations team supports WellMed Medical Management by delivering patient-centered, clinically collaborative medication consultations to help people live healthier lives. Our team focuses on the design, execution, and delivery of telephonic and digital engagement strategies designed to close STARs measure gaps in care, e.g. medication adherence, care for older adults, statins in patients with diabetes. Our interdisciplinary service delivery team is comprised of Pharmacists, Pharmacy Technicians, Licensed Vocational Nurses, and Care Coordinators.

The Clinical Quality Call Center Senior Manager supervises and coordinates an existing team of supervisory leaders and strategic initiatives to ensure the delivery of STARs/HEDIS programs and services. The Senior Manager works with management to support effective clinical operations and provides support to clinic staff in the absence of the Clinical Quality Call Center Supervisor. Will support the Quality Improvement Clinical Programs focused on STARs/HEDIS initiatives, including CAHPS/HOS, MRP, A1c, OMW, and other central initiatives. This role does not exist but there is a critical need for a higher level call center operations management skill set to ensure that WellMed maintains its historical 4+star ratings during a period of growth and expansion. Lack of this critical leadership role would put our goals, growth, and processes at risk and prevent us from achieving a 4+ Star performance.

If you are located in Texas, you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:
  • Will have 15+ team members in their hierarchy and provides coaching and assignment direction to supervisors to ensure staff complies with all regulatory initiatives and policies and procedures, while achieving performance targets
  • May answer escalated calls from members and assists them with their inquiries
  • Conducts performance reviews
  • Supports leadership with presentation development and monitors metrics ensuring target goals are met for STAR performance
  • Adapts departmental plans and priorities to address business and operational challenges
  • Influences or provides input to forecasting and planning activities
  • Product, service or process decisions are most likely to impact multiple groups of employees and/or customers (internal or external)
  • Participates in and contributes to the overall clinical quality improvement initiatives.
  • Performs all other related duties as assigned


You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:
  • Undergraduate degree or equivalent experience
  • 5+ years of Managerial experience preferably in a health care setting
  • Extensive knowledge of the Medicare Part D, particularly the pharmacy record review, claims, billing and reimbursement rules
  • Prior work in STARS and clinical Medicare Part C gap in care closures
  • Working knowledge of HIPAA Privacy and Security Rules and CMS security requirements
  • General writing skills and ability to produce work free from typographical or spelling errors
  • Working knowledge of Microsoft Office, Internet and e-mail


Preferred Qualifications:
  • Master's degree or equivalent experience
  • Bilingual
  • PBM experience
  • Previous Call center experience


UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.

Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors., WellMed is a network of doctors, specialists and other medical professionals that specialize in providing care for 550,000+ older adults with over 16,000 doctors' offices in Texas and Florida through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Job Keywords: Management, Call Center, Senior Manager, Quality Operations, Managed Care , Texas, TX, Telecommute, Telecommuter, Telecommuting, Work at Home, Work from Home, Remote

Advertisement

2009908