Senior Manager Clinical Quality HEDIS San Antonio 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 Senior Manager, Clinical Quality is responsible for coordinating and implementing the STAR's data collection and works in collaboration with the Director of Quality to develop strategies for achieving a 5 STAR rating. This role assists with data analysis and report preparation for all required data submissions. The Clinical Quality Manager provides direction and support to the various WellMed markets in the implementation of strategies for closing care gaps. This role works closely and collaboratively with various functional areas of the delivery system to achieve the goals and objectives of the Quality Improvement Program.

This is a office based position but there may be some flexibility for this position to work from home 1-2 days per week.

Primary Responsibilities:
  • Provide leadership and support in establishing the Quality Performance Initiatives at the market level
  • Monitor and analyze large volume of electronic submissions for possible data deficit issues. Utilize internal audit tracking tools for review and validation of data integrity
  • Collaborate with physicians to execute the implementation of the clinical quality initiatives as defined by enterprise
  • Provide expertise to the training department on HEDIS / STAR measures and on the tools that support the collection of HEDIS / STAR data
  • Work with IT on the interpretation of technical specifications and impact of HEDIS / STAR measures to the data collection tools and reports utilized for the support of HEDIS / STAR measures
  • Conduct training on HEDIS / STAR measures, HEDIS / STAR data collection software and data collection strategies
  • Participate in NCQA HEDIS or Health Plan audits
  • Work with external vendors on data transmission issues
  • Analyze data for possible data integrity and data deficits
  • Analyze and trend HEDIS / STAR rates, identify barriers to improvement of rates and creating interpretive exhibits. Monitor and analyze large volume of electronic submissions for possible data deficit issues. Utilize internal audit tracking tools for review and validation of data integrity
  • Analyze and trend HEDIS / STAR rates, identify barriers to improvement of rates based on HEDIS supplemental submission requirements via enterprise data systems and team work processes. Provide process improvement strategies to enterprise leadership for improving data capture and outcomes
  • Develop operating budget as necessary
  • Develop and/or maintains audit, policies and procedures that support the corporate initiatives that meet State, Federal legal requirements and standards
  • Provide expertise to the training department on HEDIS measures and tools that support collection of and communication about HEDIS to the enterprise
  • Work with Enterprise on developing and implementing HEDIS member engagement strategies
  • Promote understanding, communication and coordination of all quality improvement program components
  • Coordinate reporting on quality initiatives to all appropriate committees
  • Develop operating budget as necessary
  • Maintain QI program documents, reports, and committee minutes and follows all internal privacy and confidentiality policies and procedures
  • Update QI Project templates and Work plan with assigned responsibilities
  • Attend and participate in all QI meetings
  • Perform 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:
  • Bachelor's degree in Registered Nursing or related field
  • 5+ years of healthcare experience to include experience in a managed care setting
  • 3+ years of experience with data analysis
  • HEDIS / STAR experience or participation with regulatory reporting
  • Basic understanding of quality improvement standards such as NCQA, HEDIS, CAHPS, HOS and CMS
  • Experience working with people at all levels in an organization
  • Advanced level of proficiency with Microsoft office applications, including but not limited to databases, word-processing, spreadsheets, and graphical displays
  • You will be asked to perform this role in an office setting or other company location
  • 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:
  • Masters (MBA, MHA, MPH, MN or related field)
  • CPHQ Certification
  • CHCQM Certification
  • 3+ years of process management experience
  • Healthcare Quality Improvement experience
  • Excellent training and presentation skills with solid communication capabilities and practices, both oral and written
  • Demonstrated effective organizational skills
  • Excellent communication, writing, proofreading and grammar skills
  • Solid attention to detail and accuracy, excellent evaluative and analytical skills
  • Solid teamwork, interpersonal, verbal, written, and administrative and customer service skills

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies now require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles require full COVID-19 vaccination as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

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)

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: WellMed, San Antonio, Dallas, Austin, Houston, El Paso, TX, Texas