Associate Director, Quality Improvement – Remote in New Mexico

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. 

The Director, Quality is the primary health plan leader accountable for establishing and implementing an effective quality improvement program essential to meet NCQA as well as requirements of the state and CMS. In addition, this position provides oversight for the Critical Incidents team and has responsibility for submitting reports on, all quality measures including state performance measures and tracking measures, issues related to CI reports and any ad hoc requests from the NM HCA.

 

Lines of business in New Mexico include Medicaid, Long Term Service Support, and Dual Special Needs Plan (DSNP).  This position will report directly to the Chief Medical Officer/ Medical Director.  Must reside or be licensed in New Mexico.

 

The Director must work to ensure compliance with state and federal requirements and performance against standardized metrics, including accreditation, Healthcare Effectiveness Data and Information Set (HEDIS), New Mexico Department of Medicaid/Health Care Authority (HCA) and CMS Stars Quality Rating System, Consumer Assessment of Healthcare Providers and Systems (CAHPS) and other Quality measures. 

 

The individual will interface regularly with individuals internal, especially the QOC, CI and QOI National teams in all things related to Quality as well as those external to our organization at all levels. This position coordinates across various areas such as Clinical, Operations, National Quality teams, Pharmacy, Behavioral Health, other National teams, State Health Care Authority, CMS, and competitor health plans.

If you are located in New Mexico, you will have the flexibility to work remotely* as you take on some tough challenges. 

Primary Responsibilities:

• Provide primary oversight for quality initiatives that meet contractual requirements 
• Develop and manage the health plan’s portfolio of improvement projects, including ensuring impact at a population level and identifying and prioritizing initiatives to align with the New Mexico HCA’s Quality Bureau 
• Oversee health plan improvement teams and coordinate QI training for health plan staff 
• Apply QI tools and methods to health plan improvement projects 
• NCQA readiness, accreditation, and ongoing compliance with NCQA requirements 
• Oversight of the MMP Critical Incidents team 
• Establishing and implementing governance and oversight of health plan quality program, including coordination of committee structure described in the health plan quality improvement program and the QAPI 
• Developing and implementing programs and processes to achieve HEDIS and state value-based purchasing program requirements 
• Providing effective leadership and management oversight of direct reports and members of the quality team to build a high performing team 
• Serve as primary liaison with United Health Care (UHC) National Quality Team, effectively leveraging and coordinating national quality team resources and initiatives with local health plan quality resources, initiatives, and requirements 
• Serve as a primary driver of Performance Improvement within the health plan, including committee oversight, work plans and annual evaluation 
• Partner internally (to include HP executive leadership team and staff, QI Directors from other states and national quality teams) and externally (to include: the state, CMS, providers, and community-based organizations) as needed to improve quality across the plan 

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 
• NM -licensed registered nurse, or physician’s assistant or be certified as a Certified Professional in Health Care Quality (CPHQ) by the National Association for Health Care Quality (NAHQ), and/or Certified in Health Care Quality and Management (CHCQM) by the American Board of Quality Assurance and Utilization Review Providers prior to employment or within 6 months of the hire date 
• 5+ years clinical or healthcare experience in clinical quality or population health management 
• 5+ Health care and/or insurance industry experience, including a general knowledge of regulatory and compliance 
• 5+ years of experience in a Manager/Director role with adaptable leadership skills with the ability to achieve results in a complex organization by aligning goals with employees that are not part of the Quality Director’s direct reports 
• 5+ years of experience implementing effective HEDIS programs and NCQA accreditation 
• Experience managing and coordinating regulatory audits including documentation, onsite preparation, and responsive corrective action plans 
• Experience and familiarity with audit processes to include External Quality Review Organizations (EQRO) 
• Experience creating presentations and working with data to formally present information to physicians, administrators, state regulator, other providers, and community partners 
• Knowledge of social determinants of health in rural and urban setting in the New Mexico in order to address quality initiatives 
• Intermediate software applications skills that include, Microsoft Word, Excel, PowerPoint to include
• Demonstrated ability to lead business initiatives to a successful result 
• Demonstrated effective communicator; capable of effectively presenting ideas and selling concepts and tactics; excellent writer, proven ability to communicate effectively with executive-levels; ability to quickly understand needs and act on those needs; ability to conceptualize and effectuate change management and «out-of-the-box» thinking 
• Demonstrated ability to build relationships cross-functionally and lead toward common goals 
• Demonstrated ability to review data and make recommendations for clinical interventions in consultation with Health Services Department, Population Health Director, Health Equity Director and the Plan CMO
• Reside in the state of New Mexico or willing to relocate

Preferred Qualifications:

• Advanced degree Nursing or Public Health or Business
• Six Sigma Certification
• Reside in the state of New Mexico

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $110,200 to $188,800 annually based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes – an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

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