Director, Quality Improvement & STARs - Medicare - Pearland, TX

Director Quality And Star Improvement

Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation's leading health care organizations and build your career at one of our 40+ locations throughout Houston. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs. Join us and discover the meaning behind Caring. Connecting. Growing together.

Primary Responsibilities:

• The Director leads the development and execution of the health plan's Quality and STARs improvement strategy, ensuring solid HEDIS and STARs performance. This role establishes key objectives related to clinical gap closure, disease management, health outcomes, and member experience.
• The Director oversees the full lifecycle of member communications, collaborating with internal stakeholders to implement an effective annual communications plan across all product lines.
• In partnership with other health plan teams, the Director analyzes data and environmental factors to strengthen relationships with members, providers, and community partners, supporting the organization's overall member experience strategy.

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:

• 8+ years of leadership/management experience in the Health Plan Industry and Operations, including experience in HEDIS clinical quality and process improvement
• 8+ years in customer retention or a role requiring relationship management and/or marketing/sales and/or program development and measurement
• Experience with NCQA's HEDIS data submission process and audits
• Proven knowledge of CMS Quality Ratings, Stars ratings and NCQA accreditation measurements and methodologies
• Experience in provider education programs
• Proven working knowledge of CMS Risk Adjustment requirements

Preferred Qualifications:

• 5+ years of experience in health plan operations
• Ability to be a critical thinker, evaluate merits of new and innovative ideas, and make sound decisions
• Demonstrated solid influence, and the ability to partner with Clinical resources to enable practice transformation
• Ability to create solid relationships and work with Clinical Directors, Medical Directors, Sr. Leadership, as well as business and technology partners to plan, direct and develop clinical programs
• Ability to be a solid communicator and extremely comfortable presenting program objectives, scope, and process across segments

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). The salary for this role will range from $112,700 to $193,200 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.