Quality Program Manager -Irvine, CA

Requisition Number: 2356005
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The Quality Program Manager is responsible for managing planning, implementation and reporting for quality focused programs that improve the health, well-being, and quality of care and service received by our members, as demonstrated by high quality measure performance in HEDIS Medicaid and CMS quality measures. This role will provide programmatic support for the quality program, including coordinating direct patient/ clinician outreaches, education, care reminders, specialist/ behavioral health referral support and quality performance reviews, to advance patient education and increase patient compliance. The role will partner directly with Quality Clinical Nurse Practitioner, Pharmacists, dedicated Medical Assistant, and also collaborate with internal and external key stakeholders, regional operations, IPA practices, FQHCs, and other community partners, to drive clinical relationships and engagements between members and the care delivery system. The focus of this role is Medicaid and Duals quality metric performance, which may include but is not limited to HEDIS, CMS Stars, Part D measure gap closure, and CAHPS/HOS patient experience performance.
Hours for this role are Monday through Friday 8AM -5PM within PST.
Please note this is a Hybrid Based role and you will be required to work 3 days a week in the office, located at 9 Technology Dr. Irvine CA 92618.
The ideal candidate will be:

• Self-directed, able to manage multiple priorities, and coordinate complex cross-functional project plans, to drive execution of strategies.
• Accountable for demonstrating improvement in quality, patient experience and optimized patient outcomes.
• Skilled at utilizing data to drive decisions and has a passion for applying technology to achieve systematic solutions.
• Passionate about continuous improvement, streamlined processes and workflow optimization.
• Energized by new challenges, thrives in a fast-paced, dynamic environment, collaborates well in a collaborative atmosphere.

Primary Responsibilities:

• Under direction of the VP, Government Programs and in collaboration with other stakeholders, the Quality Program Manager will project-manage implementation of strategic quality focused programs that improve the overall health and service provided to our Medi-Cal patients. The goals of the program may include:
  • Managing workflows for patient educational and reminder outreach calls to targeted patients (e.g., high risk patients with a recent ED discharge, patients with multiple chronic conditions, such as diabetes and hypertension)
    • Tracking patient outreach registries
    • Tracking patients who received counselling and educating regarding clinical and behavioral health benefits, health plan network and other programs and tools available to help improve quality of lifestyle
    • Tracking patients with an established plan and/or various patient opportunity cohorts
    • Helping coordinate and track follow up care received after scheduled labs, screenings, post ED visits, specialist and/or behavioral health referrals, and repeat ED utilization
  • Supporting engagements to targeted clinicians with high volumes of high-risk patients with multiple chronic conditions, ED visits and those needing education on quality measures
    • Ensuring clinicians receive education on measure requirements
    • Support in reviewing strategies to reinforce Rx therapy and Medication Adherence
    • Managing clinician behavioral health and substance abuse assistance programs
    • Liaising with provider offices on labs, refill orders and prior authorizations
    • Support with scheduling outreach to providers in suspected medication abuse situations
• Responsible for tracking, trending and reporting effectiveness of quality programs for executive leadership and health plan grant reporting (e.g., targeted measure results, program reach and participation, demographic data, providers engaged, etc.)
• Optimize partnerships/ synergies with other accountable business units (e.g., Population Health, Provider Relations, Clinical Services, Marketing, Legal/Compliance, etc.)
  • Help organize and participate in cross-team program collaborations through detailed, time/role-specific project plans, to ensure clear consistent direction, communication, documentation, and division of responsibility.
  • Develop and implement strategies to improve quality and patient outcomes
• Consistently support compliance by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting noncompliance, and adhering to applicable federal, state, and local laws and regulations, accreditation, and licenser requirements (if applicable), and current corporate and client policies and procedures
• Partner with leaders and other functional business areas and other duties and initiatives as assigned

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:

• 2+ years of project management experience
• Experience working with programs in HEDIS, Quality, Stars, CAHPS/HOS
• Experience in managed healthcare or care delivery operations
• Demonstrated ability to work independently, without direct supervision
• Excel - Demonstrated ability to create, manipulate and formulate Excel spreadsheets using v-lookup, pivot tables, charts and graphing
• Proven flexible, multi-prioritizing skills and time management skills
• Proven intermediate MS Office skills
• Proven PowerPoint Presentation skills
• Proven excellent communication skills
• Driver's License and access to a reliable transportation

Preferred Qualifications:

• Provider office administrative or retail pharmacy experience
• Project management certification
• Experience with Technology-based Solutions (EHRs, IVR, Texting Applications, etc.)

CLL (Common Language of Leadership) Values Based Competencies

• Achievement Drive
  • Sets ambitious stretch goals
  • Shows initiative
  • Attacks tasks with energy and confidence
  • Motivates others with infectious enthusiasm
  • Deploys self against goals and objectives
• Critical Thinking
  • Collects essential and relevant information
  • Assesses value and connectedness
  • Synthesizes information
  • Applies multiple analytical tools
  • Generates conclusions and probable best solutions
  • Runs scenarios
• Engagement Management
  • Understands what motivates people to excel
  • Builds a culture of engagement everywhere
  • Tracks engagement and adjusts to feedback
  • Reacts to early warning signs of disengagement
  • Runs a collaborative team
• Leveraging Innovation
  • Anticipates opportunities
  • Generates and collects ideas
  • Synthesizes and combines ideas
  • Translates ideas into products/services
  • Creates an innovative friendly culture
  • Supports all innovation
• Personal Impact Management
  • Assesses their personal impact against requirements
  • Develops a style aligned to culture
  • Manages their leadership shadow
  • Gets feedback on personal impact and effectiveness
• Task & Project Management
  • Defines goals and outcomes
  • Aligns and deploys people, resources, tasks, and timelines
  • Uses on-going measurement and adjustment process
  • Provides on-time feedback and guidance

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $91,700 to $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable.
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.
OptumCare 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.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment