POSITION DESCRIPTION The Vice President, Quality Operations position will report to the SVP, Quality Operations & Performance Management, and will maintain responsibilities for Quality Operations activities for OptumCare to support high priority contracts. This role will provide strategic leadership and oversight for Quality chart reviews and pharmacy Part D Stars measures. They will be responsible for planning, organizing, and directing the administration of the activities for the centralized services and will also provide leadership to and is accountable for the performance and direction of multiple layers of management and senior level professional staff. The VP is responsible for coordinating with appropriate personnel to meet operational program needs and ensures compliance with state / federal health plan requirements, Medicare guidelines, NCQA, and health plan requirements. They will be accountable to provide long-term planning and oversight to ensure activities are appropriately integrated into strategic direction and operations, as well as the mission and values of the company. You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. PRIMARY RESPONSIBILITIES:

• Provides leadership and support in establishing and directing the Stars Quality Operations Program for OptumCare to include HEDIS chart abstraction, primary source validation, and call center activities for medication adherence and other clinical HEDIS / Star measures
• Develops and maintains policies and procedures that support the corporate initiatives that meet State / Federal legal requirements and standards
• Collaborates with physicians to execute the implementation of the clinical quality data initiatives as defined by enterprise and Optum LCDO
• Provides expertise to the training department on HEDIS / STAR measures and tools that support collection of and communication about HEDIS / STAR to the enterprise
• Develops HEDIS / STAR member and provider engagement strategies
• Collaborates with CDOs to execute HEDIS / STAR strategies
• Works with CDO Quality leadership team to provide HEDIS / STAR reporting and to develop strategic direction
• Facilitates, integrates, and/or coordinates the implementation and evaluation of identified quality improvement / HEDIS / STAR activities as requested by CDO or health plans
• Promotes understanding, communication, and coordination of all quality improvement program components
• Participates in requested evaluations and audits for UHC and other health plans
• Coordinates reporting on quality initiatives to all appropriate committees
• Participates in various teams, committees, and meetings at any level required to maintain business necessity
• Maintains current knowledge of regulatory requirements associated with the QI program
• Oversees HEDIS data submission process to all contracted health plans
• Leads the coordination and completion of projects with cross-functional teams and senior leaders across medical / nursing / clinical functional areas to achieve targeted clinical strategic performance goals
• Oversees medical / nursing / clinical workflow mapping, performance monitoring, and coaching site visits in clinic settings using process improvement methodologies to identify workflow gaps and establish future-state recommendations
• Directs medical / nursing / clinical best practice identification and standardization adoption in clinical settings with cross-functional teams and senior leaders
• Directs and promotes clinical support for clinic staff and nursing roles (RN / LVN Health Coach) with subject matter expertise and resources for population management, nurse advocacy and development opportunities, and nurse coaching / feedback programs

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:

• 4-year degree
• Active, unrestricted Registered Nurse license
• 8+ years of management experience in managed care
• 4+ years of experience working directly with quality programs, including strong working knowledge of NCQA, HEDIS requirements, and CMS STAR requirements
• 4+ years of experience at a Director level or higher
• 4+ years of operational responsibilities including budgeting, quality metrics, reporting, P&L
• Demonstrated knowledge of the business environment and business requirements (e.g., strategy changes, emerging business needs)
• Ability to establish and maintain effective working relationships with employees, managers, healthcare professionals, physicians and other members of senior administration, and the general public
• Excellent verbal and written communication, presentation, and facilitation skills
• Knowledge of fiscal management and human resource management techniques
• Ability to travel up to 30%, primarily to San Antonio location and for other business needs

PREFERRED QUALIFICATIONS:

• Advanced degree

CAREERS WITH OPTUM. Here's the idea. We built an entire organization around one giant objective; make the health system 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) *All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy. Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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. OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Job Keywords: VP, Quality, Operations, OptumCare, RN, Registered Nurse, NCQA, HEDIS, STAR, Telecommute, Telecommuter, Work from Home, Remote Job Details

• CONTEST NUMBER 840902
• JOB TITLE VP Quality Operations OptumCare
• JOB FAMILY Medical and Clinical Operations
• BUSINESS SEGMENT OptumCare

Job Location Information

• United States North America

Additional Job Detail Information

• EMPLOYEE STATUS Regular
• SCHEDULE Full-time
• JOB LEVEL Director
• SHIFT Day Job
• TRAVEL Yes, 25 % of the Time
• TELECOMMUTER POSITION Yes
• OVERTIME STATUS Exempt

A Fortune 6 company, we're focused on helping people live healthier lives while making the health system work better for everyone. Here, we seek to empower people with the information, guidance and tools to make personal health choices. We work harder and we aim higher. We expect more from ourselves and each other. And, at the end of the day, we’re doing a lot of good for more than 142 million people worldwide.