Associate Director Clinical Quality - Maricopa County, AZ - Hybrid

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.

This position requires an experienced mid-market individual familiar with the general operations of a Medicaid plan, and familiar with quality management requirements for an AHCCCS Medicaid health plan.

This position will be responsible for management of both supervisory positions and professional staff. The success of the quality program also depends upon teams outside of the department that support critical activities, and the ability to professionally communicate, influence, and build relationships with departments and staff outside span of control within a shared services environment is critical to success.

This position is responsible for direction and guidance on quality improvement and quality management programs. It is also responsible for the reporting and analysis of quality performance measures, and for the development of plans and programs to support continuous quality improvement using HEDIS and other tools.

This position is responsible for design, writing, and submission of annual evaluations and work plans to all regulators and will oversee quality audits related to regulator contractual requirements, NCQA or CMS requirements including accreditation responsibility for QI standards.

If you are located in Maricopa County, AZ, you will have the flexibility to work a Hybrid role at home and at the office location in Phoenix 2-3 days per week.

Primary Responsibilities :

• Leadership : Provide leadership to and accountable for performance of senior level professional staff
• Team Management : Manage department clinical quality improvement functions including member-focused interventions, the Clinical Practice Consultant program, and service improvement initiatives to meet all Medicaid and Medicare quality performance goals
• Collaboration : Ability to meet and collaborate with medical directors and other clinical staff as needed for improvement projects
• Annual Regulator Reporting : Design, implementation, and approval of the Quality Improvement Programs and Work plans, as well as development and approval of the annual Quality Improvement Program Evaluations
• Quarterly Regulator Reporting : Responsible for analysis, creation, and delivery of quarterly regulator required reports and submissions, and for ensuring compliance with all Quality Management requirements specified by regulator in policy or contract
• Quality Improvement Design : Responsible for selection and design of new improvement projects based upon analyses, literature review, and other quality reviews to improve member care
• Quality Improvement Interventions : Responsible for maintaining or improving performance upon all contractual and nationally required quality performance metrics, including HEDIS and customized state measures
• Hybrid Chart Audits : Oversee all clinical quality audits to ensure appropriate collection, tracking, and reporting upon medical records required for focused QI studies or regulator chart audits
• Management of external contractors : Oversight of external contractors such as HEDIS contractor and EQRO relationship and submissions
• Quality Liaison : Serve as Quality Management leader in cross-functional meetings to accomplish quality improvement and quality compliance goals, and serve as a liaison for regulators or other community-based organizations
• Committees and Presentations : Facilitates health plan quality committees by either participating as appropriate or making formal presentations for Quality Management Committee (QMC) and other leadership meetings as needed
• NCQA Accreditation : Assist with NCQA accreditation submission and any QI reports or evaluations related to accreditation

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 :

• CPHQ or RN with a current and unrestricted license in the state of AZ
• 4+ years AZ Medicaid experience in managed care quality department (health plan)
• 2+ years demonstrated leadership, team development skills and staff management
• Proficiency in software applications that include, but are not limited to, Microsoft Word, Microsoft Excel, Microsoft PowerPoint
• Located in Arizona and able to work on-site in the Phoenix office 2-3 days per week

Preferred Qualifications :

• 2+ years of NCQA Accreditation experience
• Proven success managing, implementing and auditing clinical quality programs
• Demonstrated ability to assist with focusing activities toward a strategic direction as well as develop tactical plans, drive performance and achieve targets
• Demonstrated problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action
• All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

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.

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.