Director of Clinical Quality - ProHealth Physicians

Opportunities with ProHealth Physicians, part of the Optum family of businesses. When you work at ProHealth Physicians, your contributions directly sustain the health and well-being of our community. Discover high levels of teamwork, robust medical resources and a deep commitment to exceptional care and service. Join a leading community-based medical group and discover the meaning behind Caring. Connecting. Growing together.

Primary Responsibilities:

• Strategy and execution of clinical quality improvement

• Providing subject-matter expertise on initiatives related to quality

• Managing staff completing day to day quality work such as gap closure outreach and data uploads/validations

• Analysis of member care quality and development of plans and programs to support continuous quality improvement using HEDIS and other tools

• Meeting NCQA and accreditation requirements

• Work closely and collaboratively with other ProHealth leadership to achieve the goals and objectives of quality programs

• Provide vision and leadership to take quality to the next level at ProHealth

• Deployment of accurate and up-to-date policies and procedures for meeting State & Federal legal requirements and standards; maintain current knowledge of regulatory requirements associated with quality programs

• Collaborate with clinicians to implement quality-related initiatives

• Provide oversight for quality related functions through management of quality staff

• Manage professional relationships and interactions with cross-matrixed legal and compliance teams

• Provide leadership and mentoring for staff

• Provide subject-matter expertise to quality-related training programs

• Oversee the development of resources and reference tools for quality-related staff, clinicians, and other clinical staff as necessary

• Improve job and operational efficiency; provide constructive information to minimize problems and increase employee satisfaction

• Provide information and data as requested to ProHealth and Optum leadership

• Provide clear and concise communication and coordination of all quality-related program components within ProHealth

• Participate in requested evaluations and audits

• Coordinate reporting on quality initiatives to all appropriate committees and stakeholders

• Participate on various teams, committees and meetings at any level required to maintain business performance

• Travel within the Connecticut market and/or nationally as necessary

This position will report to the Chief Medical Officer.

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:

• 8+ years of work experience which includes experience in cross-functional business areas such as general management, strategic planning, and people/relationship management

• Extensive experience in the Healthcare industry, in a clinic, medical group, or health plan setting

• Extensive experience with pay for performance and/or risk programs (CMS 5-Star, ACO, P4P,MACRA)

• Extensive experience with coding (ICD, CPT, HCPC, etc.)

• Solid working skills and knowledge of quality, quality improvement processes and programs

• Proficient with Microsoft Word, Excel, PowerPoint

• Proven critical thinking skills; this position will evaluate merits of new and innovative ideas and make sound decisions

• Proven ability to manage up, laterally and within non-traditional matrixed structures by influence; this position will partner with clinical resources to enable practice transformation

• Proven solid relationship building skills

• Proven capability working with people at multiple levels organization, multiple locations, multi-function

• Proven excellent training and collaboration skills

• Proven ability to analyze data/reports and make recommendations

• Proven exceptional organizational, detail and accuracy skills

• Proven excellent communication (written/verbal) skills

• Proven evaluative and analytical skills

• Proven solid team player, interpersonal, customer service skills

• Proven highly effective written, oral, and persuasive communication skills

Connecticut Residents Only: The salary range for this role is $104,700 to $190,400 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.

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.