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　　The Director of Quality Management for North Carolina leads the implementation of health plan Medicaid quality program, with a strong focus on health equity, in collaboration with the Chief Medical Officer. Supports the implementation of health plan Medicaid quality program, with a strong focus on health equity as well as health outcomes improvement. This is a key NC Department of Health and Human Services-facing role and leads efforts supporting NCQA accreditation, HEDIS reporting, EPSDT programs, and other regulatory compliance functions. This position is responsible for the design, writing, and submission of annual quality program evaluations and work plans to regulators and accrediting bodies, and will oversee quality audits related to contractual and accreditation requirements. The successful candidate will also have responsibility for directing performance data collection, analysis and reporting to all key internal and external stakeholders. The person in this role is expected to work directly with members of health plan leadership and to build relationships across the plan and enterprise. The individual must be comfortable with creating presentations and working with data to formally present information to providers, administrators, and state regulatory partners.

　　This role will supervise a team of clinical quality program staff within the UHC Community Plan of North Carolina. This role will collaborate with peers and will report directly to the Chief Medical Officer.

　　This role may require travel within the state of North Carolina up to 30% of the time. Travel will be required to State sponsored meetings and to the Greensboro or Raleigh office and may also include travel to provider sites.

　　If you live in North Carolina, you will have the flexibility to work remotely* as you take on some tough challenges.

　　Primary Responsibilities:

　　· Establishes the annual Quality Management and Improvement Plan (QMIP), adhering to not only state requirements, but also those extended by accrediting bodies; evaluates the influence of the QMIP annually

　　· Creates an annual QMIP work plan (WP) to address opportunities realized upon prior year evaluation of effort and assesses progress at defined intervals; evaluates the successes/continuing and/or new opportunities derived from WP activity annually

　　· Partners with Clinical Quality Leadership and other health plan leaders to ensure integrated quality oversight processes are in place to carry out the QMIP and WP, maintain compliance with contractual requirements, and NCQA standards

　　· Convenes various quality committees and workgroups as needed to enable appropriate action regarding QMIP goals and WP objectives

　　· Provides leadership to department personnel as well as to the various quality programs and improvement activities initiated and delivered by the plan

　　· Designs clinical quality transformation through targeted creation of overall improvement program/process framework based on applicable research and evidence-based guidelines, and in consideration of all stakeholders: members, practitioners, providers, community-based entities, and organizational processes/resources

　　· Oversees the collection of valid and reliable data, facilitates appropriate quantitative and qualitative analysis as needed to identify sound and meaningful corrective action, and monitors for timely intervention via established quality committee structure

　　· Recommends performance improvement programs, based upon industry standard, evidence-based best practices

　　· Produces state-required quality-related report deliverables, such as the Quality Assessment and Performance Improvement (QAPI), to defined expectations for content as well as timeliness

　　· Directs as applicable process improvement plans and corrective action plans for accreditations surveys, external quality reviews and state audits, within the scope of Quality Management and Improvement

　　· Support larger regional and market team by sharing expertise and serving as a touch point/SME for contracting and account management questions

　　· Evaluate and provide feedback to improve performance of provider support personnel, inclusive of clinical and non-clinical personnel

　　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.

　　Years of post-high school education can be substituted/is equivalent to years of experience

　　Required Qualifications:

　　· NC Licensed Clinician (e.g. LCSW, RN, MD, DO, etc.)

　　· 5+ years of demonstrated quality management/quality improvement program experience in a large healthcare corporation serving Medicaid beneficiaries

　　· 5+ years working with HEDIS measures and instituting appropriate interventions

　　· 5+ years of management/supervisory experience

　　· 5+ years of experience working with managed care accreditation and regulatory requirements (NCQA, EQRO etc.)

　　· Excellent knowledge of the Medicaid market

　　· Advanced knowledge base of clinical standards for both preventive and chronic condition health care, regulatory processes, NCQA accreditation requirements, and HEDIS measures

　　· Proficient Microsoft Office skills with exceptional analytical and data representation expertise; Advanced Excel, Outlook, and PowerPoint skills

　　· Proven ability to solve process problems crossing multiple functional areas and business units

　　· Proven ability to analyze problems, draw relevant conclusions, and devise and implement an appropriate plan of action

　　· Reside in NC

　　Preferred Qualifications:

　　· Experience having direct accountability for managing a quality program for Medicaid

　　· CPHQ Certification

　　· Six Sigma training

　　· Project management experience

　　*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.