At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to startCaring. Connecting. Growing together.If you are located in Florida, you will have the flexibility to work remotelyas you take on some tough challenges.Primary Responsibilities:Responsible for all aspects of NCQA and HEA accreditations, Adverse and Critical Incidents, HSAG Annual Technical Report and CAHPSResponsible for the overall management and full accountability for NQCA Accreditation including but not limited to: Trilogy Documents, related committee presentations, CAHPS, Health Equity Accreditation and any related action plansCompletion and timely submission of required documents: QI Program Description, QI Workplan, QI Evaluation, BOD Presentation, CAHPS Report and Action Plan, MRR SummaryManagement of Adverse (AI) I and Critical Incidents (CI) reporting. Working with CM teams on detailing findings of Root Cause Analysis associated with AIs and CIsWorking with CM teams on detailing findings of Root Cause Analysis associated with AIs and CIsProactively manages and responds to rapidly changing state requirements and environmentsOversees the implementation of plan quality management components, including quality management committee oversight and governance structureCollaborates across business segments to attain or maintain the plan’s compliance with NCQA accreditation standards and contractual requirements as they apply to the quality management programDevelops and maintains positive relationships with the state External Quality Review Organization (EQRO) within the scope of the quality management programProvides explanations and information to others (i.e. providers, provider staff, intradepartmental teams) on issues and data around Quality measuresAnalyze metrics, summarize key business learning, and translate into tactical plans (PCOR, Practice Assist and other Data lists)Make recommendations and implement quality improvement interventions based objective informationEnsure work is meeting regulatory requirementsCommunicate ideas clearly and concisely to multiple audiencesUse data analytics, assist with the identification of opportunities for quality improvement at multiple levels
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