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The Director of Clinical Quality provides strategic leadership and direction for quality outcomes and quality improvement programs of UnitedHealthcare Community Plan of Michigan. The Director of Clinical Quality works within and across matrixed health plan and shared service functions to develop and lead a proactive and evolving quality infrastructure, incorporating performance improvement, program evaluation, regulatory adherence, and accreditation compliance, for products and programs as directed by plan leadership. This position provides strategic insight and direction to the plan to align with a changing health care landscape as it applies to quality reporting and clinical performance improvement. This position develops and maintains strong relationships with state regulators, provides leadership input to expand and support member and provider engagement, and participates in advocacy activities at the state level. The Director of Clinical Quality is ultimately accountable for maintenance of the plan’s accreditation, ongoing compliance with contractual requirements related to quality, and for coordinating multi-disciplinary quality improvement strategies to improve the plan’s performance in care delivery and member health outcomes.

Job Components:

• Population Health Management Program Oversight

• Quality Improvement

• Accreditation and Regulatory Adherence

• Internal and External Advocacy and Relationship Management

• Fiscal Management

• Employee Engagement and Development

Primary Responsibilities:

• Oversees the development and implementation of the plan’s Population Health and Quality Assessment

• and Performance Improvement programs

• Coordinates work across plan and shared services partners, utilizing the expertise, standard process, and

• capabilities of these areas to enhance health plan performance

• Prioritizes work, including key deliverables such as the Trilogy Documents, Performance Improvement

• Projects, and annual performance measure reporting

• Directs quality improvement activities to improve outcomes for identified priority populations,

• including but not limited to adult and pediatric preventive care, maternity care, care for chronic

• conditions, behavioral health care, and members with special healthcare needs

• Directs population health data analytics, enabling ongoing identification of improvement opportunities

• for populations served, and incorporating concepts of health equity, social drivers of health, and health

• literacy into improvement strategies

• Monitors shared services partners, holding them accountable for thorough and fully compliant

• performance measure reporting (e.g., HEDIS®, CMS 416)

• Oversees the plan’s compliance with accreditation standards and contractual requirements as they apply

• to quality, implementing programs and solutions as needed, and escalating risks when identified

• Develops and maintains positive relationships with regulators and other key regulatory stakeholders

• Directs the health plan’s Quality Improvement Council and associated sub-committees, incorporating

• functional areas from across the organization to maintain integrated, holistic oversight

• Oversees and directs as applicable process improvement plans and corrective action plans for surveys,

• accreditation, state audits, etc., within the scope of quality management and improvement

• Oversees pilots, new, and ongoing programs in alignment with the budget, requirements for vendor

• compliance, and health plan expectations

• Interviews, hires, and supervises department staff

• Develops, mentors, and coaches staff

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:

• Michigan licensed registered nurse, physician or a Certified Professional in Healthcare Quality (CPHQ)

• 5+ years of experience leading integrated and progressive health care quality improvement programs

• 5+ years of significant leadership and managerial experience

• 5+ years of experience with demonstrated functional knowledge, process improvement initiatives and organizational behavior

• Expert knowledge of the managed care/health insurance industry, products, and services

• Experience leading accreditation surveys

• Experience working closely with state regulators

• Experience leveraging nationally standard performance measure sets for monitoring of care and service

Preferred Qualifications:

• Excellent written and verbal communication skills; superior communication abilities with executive leaders and regulators

• Superior skills in influence and negotiation, team building, and motivation

• Excellent planning and strong problem-solving skills; independent decision maker and risk taker

• Solid change management experience and demonstrated skill in staff development

• Commitment to anticipating, understanding, and meeting the needs of internal and external customers

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.