Opportunities with Optum in the Tri-State region (formerly CareMount Medical, ProHEALTH New York and Riverside Medical Group). Come make a difference in the lives of people who turn to us for care at one of our hundreds of locations across New York, New Jersey and Connecticut. Work with state-of-the-art technology and brilliant co-workers who share your passion for helping people feel their best. Join a dynamic health care organization and discover the meaning behind Caring. Connecting. Growing together.
The Optum Health East region is seeking an experienced quality leader to drive performance and improve overall quality outcomes in value-based programs across Medicare, DSNP, Medicaid, and Commercial products. This leader provides direct oversight on all aspects of quality and provider enablement including functional teams responsible for quality program operations, provider outreach and education, patient engagement, management of technology solutions, and quality submissions to payers and other regulatory agencies. This position reports directly to the President of Risk Bearing Entities, Optum Health East and collaborates cross functionally with internal subject matter experts across medical management, market operations, healthcare economics, risk adjustment, network development, payor contracting, and finance.
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You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
- Serves as the subject matter expert in the region for all quality programs
- Oversees comprehensive value-based quality performance improvement programs across all employed care delivery organizations (CDOs) and IPA providers
- Establishes solid working relationships with the clinical and operational leaders across employed CDOs to ensure the prioritization of and achievement of quality program incentives
- Provides overall direction to ensure quality programs are provided in accordance with standards established through state and federal regulations, the Center for Medicare and Medicaid Services, and other relevant accreditation agencies
- Oversees outreach strategy and informs the workflows, policies, and procedures that govern engagement with patients that are due or overdue for annual visits and gaps in care
- Oversees chart abstraction, patient engagement, and medication adherence team to optimize part D performance
- Leads the evaluation, contracting, implementation, and management of a wide range of vendors that support quality programs across CDOs and IPA providers
- Ensures the timely submission of supplemental data to payers and seeks to automate data flows where possible
- Ensures compliance with and success in value-based care programs across all lines of business
- Collaborates with Optum national teams and other regions to share and exchange best practices
- Monitors historical and current data trends and CMS notifications related to quality to make recommendations and predictions
- Builds talent bench and promotes a positive culture across the team
- Collaborates with analytics to develop reporting solutions to measure ongoing performance
- Leads the network to drive innovative initiatives that address low performing measures
- Drives continuous improvement through a holistic and well-run inspection/remediation process and delivery
- Empowers quality improvement leads and practice performance managers to develop comprehensive, practice/provider-specific plans to increase quality performance and improve outcomes
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:
- 10+ years of experience leading Stars, HEDIS, pharmacy and member experience initiatives with proven history of performance improvement over time
- 5+ years of leadership experience in areas including: quality improvement; healthcare consulting, and/or population health
- Exceptional knowledge and experience with nationally recognized quality programs/measures (Stars/PCMH/ACO/MIPS) and provider engagement strategies
- Deep understanding of implementing best practice work flows to improve quality performance across employed and IPA providers
Preferred Qualifications:
- Health plan leadership experience
- IPA operations management experience
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The salary range for this role is $147,300 to $282,800 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
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.