Job details
Job type full-time
Full job description
For those who want to invent the future of health care, here`s your opportunityWe`re going beyond basic care to health programs integrated across the entire continuum of careJoin us and help people live healthier lives while doing your life`s best work.(sm)
The quality and credentialing special projects manager is responsible for following key quality functions with united healthcare community plan of hawai’iThe person in the role will be responsible for leading, coordinating, monitoring and maintaining the requirements for the credentialing and re-credentialing process and any other assigned special projects along with providing delegation oversight, implementation support, measurement standards, and revisions as needed that incorporate applicable best practices with proven outcomes.
Primary responsibilities:
Manage special quality activities and credentialing/re-credentialing oversight, consistent with regulatory requirements per the department of human services/med-quest division (mqd), centers for medicare and medicaid services (cms), and the national committee on quality assurance (ncqa)
Serve as a liaison to vendor(s) and/or internal/external stakeholders to ensure timely completion of projects
Development of strategy and action plan to address any assigned corrective action plan
Provide oversight to credentialing, re-credentialing and special projects, policies and procedures, recommending, and editing new policies as neededReview and edit policies and procedures to ensure content is aligned with regulatory requirements and national policiesMonitor and respond to ongoing changes in regulatory requirements
Responsible for providing oversight for any delegated function pertaining to credentialing/re-credentialing and any other special projects
Coordinate with the health plan leadership and national representatives to ensure compliance with credentialing and re-credentialing processes
Present updates, reports, etcTo quality committees as needed
Conducts performance improvement projects (pips) and complete submission of necessary reports
Collaborate with internal and external entities for quality improvement activities, including pips
Provide guidance and oversight for cahps improvement activities and other projects as assigned
Present quality improvement activity updates and outcome to appropriate committees
Analyze data from multiple sources and develop quality improvement activities
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:
Bachelor’s degree or 2+ years of experience in the health care field
Quality improvement experience
Knowledge of regulatory agencies including ncqa
Experience with ms word, excel, powerpoint, outlook
Preferred qualifications:
Master’s degree or higher
1+ years of experience working in a health plan, hospital, or office setting in quality management
Quality improvement certification
Experience with credentialing and re-credentialing processes
Experience with interpreting quality standards, contracts and letters of direction
Project or program management experience leading projects, managing timelines and deliverables
Experience in analyzing process outcome metrics to determine effectiveness of programs, working with large data sets and making data-driven analytical decisions
Strong influencer with demonstrated skills in innovative thinking to optimize health care system
Proven experience managing change initiatives
Experience with lean, six sigma or similar methodologies
Lean six sigma certification
Qi project experience with qip and pips (quality improvement projects)
Experience with outside audit organizations such as eqros
Proven ability to build relationships cross-functionally and lead toward common goals
Experience leading complex projects where deadlines and scope shift frequently, with the ability to adapt to change while maintaining strong relationships with stakeholders; leveraging data to drive sound decisions and deliver quality projects
Unitedhealth group requires all new hires and employees to report their covid-19 vaccination status.
Careers at unitedhealthcare community & stateChallenge brings out the best in usIt also attracts the bestThat`s why you`ll find some of the most amazingly talented people in health care hereWe serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, hiv/aids and high-risk pregnancyOur holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factorsJoin usWork with proactive health care, community and government partners to heal health care and create positive change for those who need it mostThis is the place 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: 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 workplaceCandidates are required to pass a drug test before beginning employment
Keywords: quality & credentialing special projects manager, telecommute, telecommuter, telecommuting, work at home, work from home, remote, honolulu, hi, haiwii
