CDQI Regional Manager - CCM & Screening Program - Telecommute US at UnitedHealth Group

Pittsburgh, PA

About the Job

If you want to achieve more in your mission of health care, you have to be really smart about the business of health care.  Challenge yourself, your peers and our industry by shaping what health care looks like and doing your life’s best work. (sm)
CDQI (Clinical Documentation & Quality Improvement) is charged with effectively implementing, monitoring, and executing on clinical documentation and quality programs that promote patient health while improving the provider practice experience with a special focus on Medicare Risk Adjustment and HEDIS.  CDQI processes on a national level by providing support in all markets served by OptumCare Delivery & OptumCare Services
This position will report into the CDQI Director of Market Relations and will be responsible for supporting the CCM (Complex Care Management) Regional Associate Director in cultivating relationships and driving implementation of Risk Adjustment & Quality initiatives for CCM OptumCare Services organizations. This role will also drive operational implementation and management of screening equipment programs across Care Delivery and Care Services (i.e. QuantaFlo).
Primary Responsibilities:
  • Primary support resource for CCM Regional Associate Director to ensure consistent support and value to CCM
  • Secondary contact for CCM organization leadership and staff
  • Ownership and Management of CDQI and CCM deliverables as it relates to Risk and Quality Initiatives – specifically:
    • Serve as Operations lead for Chart Review Team
    • Summarize findings of reviews and participate in the development of education programs for long-standing results
    • Support Regional Associate Director to summarize global findings for education programs and programmatic risk and quality opportunity
    • Serve as liaison between market, chart review team, and chart retrieval vendor
    • Develop, manage, and lead chart retrieval operations for remote chart review team
    • Manage vendor costs and monitor ROI for chart retrieval
    • Manage Chart Review Program
    • Develop reportable metrics to gauge performance on a market by market level
    • Use reporting and feedback to drive continuous improvement
  • Program Manager for screening equipment deployment and maintenance (i.e. QuantaFlo) for Care Delivery and Care Services
  • Lead/facilitate meetings to drive execution of initiatives
  • Attendance at meetings for broader Care Delivery initiatives
  • Drive delivery and maintain project plan timelines
  • Ensure prompt escalation of challenges/issues that will impact the business and initiative delivery
  • Partner with internal CDQI team to provide tools and materials for CCM
  • Collaborate with peers to maintain CCM knowledge across the team

Required Qualifications:
  • Undergraduate degree or equivalent experience
  • 5+ years of solid Project Management experience and successful project delivery 
  • Good understanding of Project Management methodology and best practices
  • Previous experience in successfully delivering on Operational projects in a matrix environment
  • Ability to work independently and in a team environment to deliver on Clinical Risk and Quality initiatives
  • Ability to influence and work with internal and external stakeholders/resources to move projects and programs forward and overcome any challenges
  • Strong personality with a keen sense of ownership and accountability and a “can do” attitude
  • Ability to manage to timelines and escalate issues as appropriate
  • Ability to simultaneously work on multiple projects and help manage project resources 
  • Documentation experience is needed including project plan
  • Comfortable with report outs and presentation to management 
  • Good communication skills both written and verbal
  • Good organization and comprehension capabilities
  • Organized and detail oriented
  • 25% travel  
Preferred Qualifications:
  • Familiarity with government pay for performance programs
  • Six Sigma certification and/or exposure
  • Well-honed communication skills (both written and verbal)
  • Ability to build strong relationships across a variety of stakeholders
  • Proficiency with Microsoft Office 
Critical Success Factors:
  • Self-starter and be able to take direction and come up with approaches and solutions
  • Excellent multi-tasking skills
  • Working in a matrix environment to drive efficiencies through influence
  • Seeks ways to improve job and operational efficiency and makes suggestions as appropriate
  • Takes ownership of the process and provides constructive information to minimize problems and increase provider and market satisfaction
  • Partners with CCM leadership teams and Optum management across markets to coordinate execution and implementation in all markets
  • Ensure activities are appropriately integrated into the strategic direction, as well as the mission and values of the company
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world’s large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life’s best work.(sm)
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.
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