DSNP Medicare Quality Manager - Hawaii
Company: UnitedHealthcare
Location: Honolulu
Posted on: May 8, 2025
|
|
|
Job Description:
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.
-
Are you a leader and subject matter expert in healthcare quality?
-Do you want to help lead Medicare quality improvement in STARs,
scope definition, risk identification, methodology and resource
allocation or facilitation? Lead strategic initiatives crossing
business teams and operating groups as our Medicare Quality Lead to
coordinate and complete projects, define performance, root cause
analysis, develop and execute strategies, and innovate and drive
local initiatives. You will determine time frames, procedures for
accomplishing project, and lead others in the organization to make
meaningful process improvements. Assess, develop, coordinate, and
implement strategies to align with national Medicare quality
activities including Stars. -Assess provider network incentive
status, data acquisition mechanisms and drive provider oversight
towards gap closures and participate in HEDIS data capture in
coordination with the health plan Quality Director.
-
If you reside in Hawaii and able to travel up to 50% of the time,
you'll enjoy the flexibility to work remotely * as you take on some
tough challenges. -
-
Primary Responsibilities:
Monitor/manage STARs measure performance and drive the health
plan's DSNP/Medicare quality and related performance measures
Report to health plan's leadership team on progress, challenges and
opportunities on DSNP/Medicare quality metrics and goals on a
regular basis
Develop strategies related to overall STAR performance and create
alternate plans to impact HEDIS/CAHPS measures
Monitor and evaluate all initiatives impacting population and
adjust strategy as needed in consultation with National STARs team
and Member Navigation Team to determine mix of channels and
delivery systems to drive 5 STAR ratings
Perform root cause analysis for poor performance on administrative
and clinical measures
Coordinate within the plan and across functional areas to resolve
and/or improve STAR and HEDIS measures
Develop and execute overall STARS strategy in collaboration with
plan leadership and National STARS team with flexibility to attend
meetings outside of Hawaii business hours
Innovate and drive local initiatives that address low performing
measures
Manage local plan personnel as needed, and other functional areas
to develop CAHPS interventions and Disenrollment Reduction
Initiatives
Monitor overall compliance and metrics in our pay for performance /
quality programs with providers related to our DSNP/Medicare
program
Monitor and work with Regulatory Reporting and Compliance teams to
ensure health plan performance with DSNP/Medicare quality and
related requirements are met
Participate in audits as appropriate
Provide subject matter expertise in STARS, HEDIS, project plans,
reporting logistics, etc.
Work with assigned providers, state, and community agencies
-
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:
5+ years in a healthcare quality improvement role
3+ years of experience in developing reports, working with large
data sets and making data - driven analytical decisions
2+ years of STARS experience
Demonstrated ability to focus activities toward a strategic
direction and achieve targets and meet deadlines
Comfortable communicating with executive leadership and external
parties including physicians and other provider leaders
Proven track record of reaching and / or exceeding performance
improvement plans
Work with minimal guidance; seeks guidance on only the most complex
tasks and can translates concepts into practice
Solid interpersonal skills and ability to excel in workgroup
environment in different roles as required, i.e. group leader,
subject matter expert or consultant, participant
Intermediate or higher level of proficiency with MS Project, Excel,
Visio, PowerPoint and SharePoint
Demonstrated ability to communicate ideas clearly and concisely
Excellent time management, organizational, and prioritization
skills and ability to balance multiple priorities
Ability to travel as needed up to 50% of the time
Hawaii resident
-
Preferred Qualifications:
STARs / HEDIS experience in healthcare
Experience working in a highly matrixed organization
Experience acting as a liaison between business, clinical, and
technical teams
Bi-Lingual
Medicare Advantage health plan experience
Project management experience
-
*All employees working remotely will be required to adhere to
UnitedHealth Group's Telecommuter Policy
-
The salary range for this role is $89,800 to $176,700 annually
based on full-time employment. Pay is based on several factors
including but not limited to local labor markets, education, work
experience, certifications, etc. UnitedHealth Group complies with
al 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.
-
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. -
Keywords: UnitedHealthcare, Honolulu , DSNP Medicare Quality Manager - Hawaii, Executive , Honolulu, Hawaii
|
Click
here to apply!
|
