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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 start Caring. Connecting. Growing together.As a key leader in the clinical operations of the Idaho health plan, the Population Health Manager will work closely with the Leadership team to coordinate an interdisciplinary approach to care. This will include a focus on health promotion, chronic disease management, behavioral health needs, and social determinants of health (SDoH). Engagement with providers and community resources will be very important. A comprehensive population health assessment inclusive of environmental and historical local drivers of health will inform a metrics and measures based population health improvement plan In partnership with other members of the clinical team, a component of the role will include provider education and monitoring of quality improvement programs. The includes analysis and review of health outcomes at the provider and aggregated patient-level monitoring, measuring and reporting on key metrics to assist providers in meeting quality and equity standards, state contractual requirements, SDoH initiatives, and pay for performance initiatives. This position will focus on planning and implementing initiatives that are needed and do so in accordance with State, CMS, NCQA, and/or other requirements as applicable.If you reside within the state of Idaho, you’ll enjoy the flexibility to work remotely as you take on some tough challenges.Primary Responsibilities:
Effective deployment and management of a program at the practice and community levels through strategic partnerships with practitioners, community partners, and internal stakeholders
Assesses trends in population/quality measures and identifying opportunities for quality improvement
Designs quality transformation through targeted interventions related to HEDIS/state specific population/quality measures
Serves as subject matter expert (SME) for population health, preventive health topics, leads efforts with clinical team to research and design educational materials
Serves as liaison with key vendors supporting population health initiatives
Consults with vendors and providers to design and implement initiatives to innovate and then improve population health programs measures
Participates, coordinates, and/or represents the Health Plan at events, state meetings, and other outreach events focused on population health initiatives and disparity programs
Identifies and addresses population-based member barriers to care and leads the team in identifying local level strategies to overcome barriers and close clinical gaps in care
Investigates gaps in clinical documentation where system variation has impact on rate calculation, implements corrective plans when issues are verified, and monitors to resolution
Creates presentations and works with data to formally present information to various stakeholders
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:
3+ years clinical or healthcare experience
3+ years of healthcare and/or insurance industry experience, including a general knowledge of regulatory and compliance
3+ years of experience in a Manager/Director role with adaptable leadership skills with ability to achieve results in a complex organization by aligning goals with employees that are not considered direct reports
3+ years of quality improvement/population health experience
Experience creating presentations and working with data to formally present information to physicians, administrators, state regulator, other providers and community partners
Experience as a senior level advocate on behalf of the member who can lead a cross departmental team to member resolution
Proficient experience working with MS Word (create, edit and save documents) and Excel (create, edit and save spreadsheets, formulas)
Knowledge of population and public health, in both rural and urban settings
Knowledge of social determinants of health in rural and urban setting in the US Southwest Region
Intermediate software applications skills that include, Microsoft Word, Excel, PowerPoint
Proven ability to review data and make clinical interventions and consult others
Dedicated work area established that is separated from other living areas and provides information privacy
Currently reside in Idaho
Ability to travel locally up to 25% of the time
Preferred Qualifications:
Current unrestricted Registered Nurse (RN) licensure in the state of Idaho or Licensed Clinical Social Worker (LCSW)
5+ years clinical or healthcare experience
5+ years of healthcare and/or insurance industry experience, including a general knowledge of regulatory and compliance
5+ years of experience in a Manager/Director role with adaptable leadership skills with ability to achieve results in a complex organization by aligning goals with employees that are not considered direct reports
Experience creating and executing a strategic plan with measurable outcomes
Experience working in Medicaid and/or Medicare
Knowledge of one or more of: clinical standards of care, preventive health standards, HEDIS, NCQA, governing and regulatory agency requirements, Population health approach and the managed care industry
Understanding and/ or experience working with the Native American and tribal communities
Background in Managed Care
All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter PolicyAt 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.
