HEDIS Quality Manager - Dallas, TX

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


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 Quality Manager is responsible for driving consistency in program implementation designed to facilitate a minimum of a 4 Star quality rating. These initiatives should result in contracted network being able to understand and support the vision to change the face of healthcare delivery for seniors. This will drive the financial viability of the market HEDIS/Star program and provide a full quality of care for the members. The responsibilities of this position demand a wide range of capabilities including: strategic planning and analysis skills; strong understanding of HEDIS and coding; management breadth to direct and motivate; highly developed communication skills; and the ability to develop clear action plans and drive process, given often ambiguous issues with numerous interdependencies. This position will facilitate any unresolved issues that remain as a result from following the standard process.

Primary Responsibilities:
  • Manages Quality Coordinators, Clinical Quality Consultants (CQC) I, II and Senior CQC and is responsible for the overall success of the market's HEDIS / Star results for contracted physicians
  • all aspects of staff development to include hiring, training, coaching and development
  • Maximizes staff performance and technical expertise through clearly defined objectives, training, skill development and leadership to ensure quality services to all customers
  • Delegate, monitor and control work progress on key HEDIS / Star metrics, initiatives / action plans, staff productivity, and administrative expenses
  • Participates in development and implementation of systems and processes that support quality operations
  • Maintains effective cross functional services by working effectively with the Medical Director, Market Medical Director, Market Operations, Regional Team, Clinic Operations and other corporate departments
  • Handles complex and/or difficult provider inquires and/or problems and facilitates resolution of provider issues. Continuously strive to ensure that favorable relationships are maintained while ensuring the interest of the organization
  • Takes ownership of total work process and provides constructive information to ensure physician partners have support to meet initiatives
  • Analyzes data while collaborating and/or participating in discussions with colleagues and business partners to identify potential root cause of issues
  • Demonstrate understanding of providers' goals and strategies in order to facilitate the analysis and resolution of their issues
  • Work with relevant internal stakeholders to identify obstacles and barriers identified by providers, and methods for removing them
  • Communicate and advocate providers' needs to internal stakeholders in order to drive creation of solutions that meet our HEDIS/Star goals
  • Communicate industry and company information to providers through various means (e.g., newsletters; emails; outreach calls; teleconference; conferences; on-site meetings)
  • Develops and coaches staff to facilitate strategic business meetings with physician groups and their staff
  • Guides, oversees and ensures competency of the Quality market staff
  • Assist corporate and local education team and provides input on tools used to education quality staff and other local provider support staff
  • Ensures all education objectives are being met, both on a formal and ad-hoc basis
  • ensuring the quality staff is responding to market operation and provider inquiries
  • Facilitates provider discussions and assists in negotiating resolution to escalated provider issues with the capability to determine if/when issues require escalation
  • Collectively works with cross functional leadership to eliminate duplication of efforts and member or provider abrasion
  • Includes up to 25% local travel
  • Performs all other related duties as assigned

This position will be based out of the office.

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 in Nursing, Ancillary Health Care, Health Care Administration, Business Administration, Public Administration, or a related field (Associate Degree with 4+ years of comparable work experience beyond the required years of experience may be substituted in lieu of a bachelor's degree)
  • 5+ years of related experience in Quality / HEDIS / CMS Stars, and ICD10 / CPT/ CPT II coding knowledge, Provider Relations
  • 2+ years of supervisory experience
  • Knowledge of Medicare quality operations including HEDIS, Stars, Coding and Medicare Advantage
  • Knowledge of state and federal laws relating to Medicare
  • Ability and willingness to travel, both locally and non-locally, as determined by business need
  • Advanced Microsoft Office skills. Proficient in Excel
  • Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance

Preferred Qualifications:
  • Master's degree in Healthcare Administration, Business Administration, or a related field
  • Project Management experience
  • Solid knowledge base of clinical standards of care, preventative health and STAR measures
  • Solid financial analytical background within Medicare Advantage plans (Risk Adjustment / STARS Calculation models)
  • Exceptional analytical and data representation expertise

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. We're impacting 550,000+ lives, primarily Medicare eligible seniors 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)

WellMed was founded in 1990 with a vision of being a physician-led company that could change the face of healthcare delivery for seniors. Through the WellMed Care Model, we specialize in helping our patients stay healthy by providing the care they need from doctors who care about them. We partner with multiple Medicare Advantage health plans in Texas and Florida and look forward to continuing growth.

**PLEASE NOTE** The Sign On Bonus is only available to external candidates. Candidates who are currently working for a UnitedHealth Group, UnitedHealthcare or a related entity in a full time, part time, or per diem basis ("Internal Candidates") are not eligible to receive a Sign On Bonus.

Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.

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

Job Keywords: WellMed, Dallas, Quality, Medicare, CMS, HEDIS, Manager, Supervisor, CQC, Medical Chart Review, Medical Records, STARS, RN, Nurse Manager, Dallas, Fort Worth, TX, Texas, Registered Nurse