The VP of Quality Metrics and Performance will be a key leader on the Clinical Performance Quality team. This leader will be responsible for identifying areas of opportunity, coordinating and providing subject-matter expertise on initiatives related to the Medicare Star Ratings program in conjunction with the local care delivery teams from a clinical first perspective and leading in a high integrity transformative capacity. Responsibilities will encompass a targeted focus on specific health plan contracts (H-contract) with a high percentage of OptumCare membership and driving improvements in performance for HEDIS, CAHPS, HOS, and Part D measures. This VP will work directly with the Care Delivery Organization (CDO) to achieve the overall H contract Star Rating goal. This individual will be responsible for H contract analytics, reporting, and strategy development to address underperforming measure rates.
From a leadership perspective the VP will work collaboratively with the CDO and health plan to execute on strategy, tactics, and initiatives. As a transformational leader, this individual will serve the needs of the CDOs and emphasize commitment and alignment on the shared purpose and goals. Through inspirational motivation, this leader will lead the teams to achieve the organizational vision, mission, and goals by encouraging innovation and quality improvement practices. They will be leading cross-functional teams and create a supportive environment that empowers achievement, growth, mentoring, and development. This position will work closely with and report to the OptumCare Senior Vice President of Quality.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
- Work closely and collaboratively with the existing quality team and the rest of the National leadership team to achieve the goals and objectives of the Star Rating program
- Lead as a clinician putting patients first
- Function as subject matter expert on HEDIS, CAHPS / HOS surveys, and Part D measures
- Develop and maintain policies / procedures that support the corporate initiatives for meeting State, Federal legal requirements and standards; Maintain current knowledge of regulatory requirements associated with the quality program
- Collaborate with physicians and other providers to execute the implementation of the clinical quality data initiatives
- Provide expertise in the training department on HEDIS measures and tools that support collection of and communication about HEDIS
- Work with OptumCare on developing and implementing member engagement strategies to improved HEDIS, CAHPS, and HOS outcomes
- Provide information / data as requested to Optum leadership
- Facilitate, integrate, coordinate the implementation and evaluation of quality improvement / HEDIS activities as requested by UHG or related companies
- Promote understanding, communication, and coordination of all quality improvement program components
- Participate in requested evaluations and audits
- Coordinate reporting on quality initiatives to all appropriate committees
- Develop operating budget as necessary and participate on various teams, committees, and meetings at any level required to maintain business necessity
- Maintain quality program documents, reports, and committee minutes and follow all internal privacy and confidentiality policies and procedures
- Oversee HEDIS data submission process and lead accreditation efforts defined by the enterprise
- Manage 2-3 direct reports (analysts, project manager, H contract SME) with expectations to grow the team over time
- Achieve a minimum of 4+ Star Rating for assigned H contract
- Build out a more durable, integrated, unified OptumCare that will outlive any one individual’s tenure
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.
- RN clinical licensure or higher (ARNP, MD, or DO) strongly preferred
- 10+ years of experience in managed care
- 8+ years of management experience including managing leaders
- 5+ years of experience with Medicare Stars (HEDIS, CAHPS / HOS, and Part D)
- 5+ years of experience presenting to a variety of audiences, senior leadership, Executive C-suite, etc.
- Proven capability working with people at multiple levels organization, preferably multiple locations and multi-functions
- Demonstrated experience in leading / transforming a business program related to quality; Examples required
- Excellent training and collaboration skills
- Up to 50% travel required primarily to the CDO(s)
- Ability to analyze and synthesize data / reports and make prudent recommendations, create initiatives, and action plans partnering with CDOs
- Proficient with Microsoft Word, Excel, PowerPoint
- Exceptional organizational, detail, and accuracy skills
- Excellent communication (written / verbal) skills; Presentation SME with market level interface
- Proven evaluative and analytical skills
- Strong team player with strong interpersonal and customer service skills
- Visionary abilities including daily tactical work and contributing to the further build out of business vision