Quality & Credentialing Special Projects Manager - Telecommute in Honolulu, HI

Careers at UnitedHealth Group

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The Quality and Credentialing Special Projects Manager is responsible for following key quality functions with United Healthcare Community Plan of Hawai'i. The person in the role will be responsible for leading, coordinating, monitoring and maintaining the requirements for the credentialing and re-credentialing process and any other assigned special projects along with providing delegation oversight, implementation support, measurement standards, and revisions as needed that incorporate applicable best practices with proven outcomes.

Primary Responsibilities:
  • Manage special quality activities and credentialing/re-credentialing oversight, consistent with regulatory requirements per the Department of Human Services/Med-QUEST Division (MQD), Centers for Medicare and Medicaid Services (CMS), and the National Committee on Quality Assurance (NCQA)
  • Serve as a Liaison to vendor(s) and/or internal/external stakeholders to ensure timely completion of projects
  • Development of strategy and action plan to address any assigned corrective action plan
  • Provide oversight to credentialing, re-credentialing and special projects, policies and procedures, recommending, and editing new policies as needed. Review and edit policies and procedures to ensure content is aligned with regulatory requirements and national policies. Monitor and respond to ongoing changes in regulatory requirements
  • Responsible for providing oversight for any delegated function pertaining to credentialing/re-credentialing and any other special projects
  • Coordinate with the Health Plan leadership and national representatives to ensure compliance with credentialing and re-credentialing processes
  • Present updates, reports, etc. to Quality Committees as needed
  • Conducts performance improvement projects (PIPs) and complete submission of necessary reports
  • Collaborate with internal and external entities for quality improvement activities, including PIPs
  • Provide guidance and oversight for CAHPS improvement activities and other projects as assigned
  • Present quality improvement activity updates and outcome to appropriate Committees
  • Analyze data from multiple sources and develop quality improvement activities

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:
  • Bachelor's degree or 2+ years of experience in the health care field
  • Quality improvement experience
  • Knowledge of regulatory agencies including NCQA
  • Experience with MS Word, Excel, PowerPoint, Outlook

Preferred Qualifications:
  • Master's degree or higher
  • 1+ years of experience working in a health plan, hospital, or office setting in Quality Management
  • Quality Improvement Certification
  • Experience with credentialing and re-credentialing processes
  • Experience with interpreting quality standards, contracts and letters of direction
  • Project or program management experience leading projects, managing timelines and deliverables
  • Experience in analyzing process outcome metrics to determine effectiveness of programs, working with large data sets and making data-driven analytical decisions
  • Strong influencer with demonstrated skills in innovative thinking to optimize health care system
  • Proven experience managing change initiatives
  • Experience with LEAN, Six Sigma or similar methodologies
  • Lean six sigma certification
  • QI project experience with QIP and PIPs (quality improvement projects)
  • Experience with outside audit organizations such as EQROs
  • Proven ability to build relationships cross-functionally and lead toward common goals
  • Experience leading complex projects where deadlines and scope shift frequently, with the ability to adapt to change while maintaining strong relationships with stakeholders; leveraging data to drive sound decisions and deliver quality projects

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

Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place 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

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