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The Quality Program Manager is responsible for managing planning, implementation and reporting for pharmacy-based programs that improve the health, well-being, and quality of care and service received by our members, as demonstrated by high quality measure performance in Part D and pharmacy-based HEDIS CMS Star measures. This role will provide programmatic support for the quality pharmacy program, including coordinating direct patient/ clinician outreach, education, care reminders, Rx prescribing support and quality performance reviews, to advance Rx therapy education and increase medication adherence. The role will partner directly with the Quality Clinical Pharmacist, and collaborate with internal and external key stakeholders, regional operations, IPA practices, FQHCs, and other community partners, to drive clinical relationships and engagements between members and the care delivery system. The focus of this role is OneCare (Duals) pharmacy-based measure quality metric performance, which may include but is not limited to HEDIS, CMS Stars and Medicare Part D measure gap closure, and CAHPS/HOS patient experience performance.
 

The ideal candidate will be:

Self-directed, able to manage multiple priorities, and coordinate complex cross-functional project plans, to drive execution of strategies Accountable for demonstrating improvement in quality, patient experience and optimized patient outcomes Skilled at utilizing data to drive decisions and has a passion for applying technology to achieve systematic solutions Passionate about continuous improvement, streamlined processes and workflow optimization Energized by new challenges, thrives in a fast-paced, dynamic environment, collaborates well in a collaborative atmosphere

 

If you are located in Irvine, CA, you will have the flexibility to work from home and in the office in this hybrid role* as you take on some tough challenges.

 

Primary Responsibilities:

Under direction of the VP, Government Programs and in collaboration with other stakeholders, the Quality Program Manager will project manage implementation of strategic pharmacy-based programs that improve the overall health and service provided to our OneCare patients. The goals of the program may include:
Managing workflows for patient educational and reminder outreach calls to targeted patients (e.g., patients at risk of falling out of medication compliance for one or more medications, newly prescribed Statin Rx, PCP referrals)
Tracking patient outreach registries  Tracking patients who received counselling and educating regarding pharmacy benefits, health plan network and other programs and tools available to help improve quality of lifestyle Tracking patients with an established plan and/or various patient opportunity cohorts Helping coordinate and track auto Rx refills, multi-month Rx conversions, and mail order Rx Supporting engagements to targeted clinicians with high volumes of patients with Part D Rx gaps and those needing education on the new Polypharmacy: Use of Multiple Anticholinergic (ACH) Medications in Older Adults, and Polypharmacy: Use of Multiple Central Nervous System (CNS) – Active Medication in Older Adults measures
Ensuring clinicians receive education on measure requirements Support in reviewing strategies to reinforce Rx therapy and Medication Adherence Managing clinician prescribing assistance programs, such as Prescribing Protocol Agreements to initiate / modify Rx on their behalf  Liaising with provider offices on labs, refill orders and prior authorizations. Support with scheduling outreach to providers in suspected medication abuse situations Responsible for tracking, trending and reporting effectiveness of the pharmacy quality program for executive leadership and health plan grant reporting (e.g., targeted measure results, program reach and participation, demographic data, providers engaged, etc.) Optimize partnerships/ synergies with other accountable business units (e.g., Population Health, Provider Relations, Clinical Services, Marketing, Legal/Compliance, etc.)
Help organize and participate in cross-team pharmacy-based program collaborations through detailed, time/role-specific project plans, to ensure clear consistent direction, communication, documentation, and division of responsibility Develop and implement strategies to improve quality and patient outcomes Consistently support compliance by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting noncompliance, and adhering to applicable federal, state, and local laws and regulations, accreditation, and licenser requirements (if applicable), and current corporate and client policies and procedures Partner with leaders and other functional business areas and other duties and initiatives as assigned

 

CLL (Common Language of Leadership) Values Based Competencies:

Achievement Drive 
Sets ambitious stretch goals Shows initiative Attacks tasks with energy and confidence Motivates others with infectious enthusiasm Deploys self against goals and objectives Critical Thinking
Collects essential and relevant information Assesses value and connectedness Synthesizes information Applies multiple analytical tools Generates conclusions and probable best solutions Runs scenarios Engagement Management
Understands what motivates people to excel Builds a culture of engagement everywhere Tracks engagement and adjusts to feedback Reacts to early warning signs of disengagement Runs a collaborative team Leveraging Innovation
Anticipates opportunities Generates and collects ideas Synthesizes and combines ideas Translates ideas into products/services Creates an innovative friendly culture Supports all innovation Personal Impact Management Assesses their personal impact against requirements Develops a style aligned to culture Manages their leadership shadow Gets feedback on personal impact and effectiveness Task & Project Management Defines goals and outcomes Aligns and deploys people, resources, tasks, and timelines Uses on-going measurement and adjustment process Provides on-time feedback and guidance

 

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:

2+ years of project management experience Experience working with programs in HEDIS, Quality, Stars, CAHPS/HOS  Experience in managed healthcare or care delivery operations Demonstrated flexible, multi-prioritizing skills and time management skills Ability to work independently, without direct supervision Proven excellent communication skills Demonstrated intermediate MS Office skills Ability to create, manipulate and formulate Excel spreadsheets using v-lookup, pivot tables, charts and graphing Proven PowerPoint Presentation skills Ability for 25% local travel within Orange County  Valid CA Driver's license, current insurance and access to reliable transportation Ability to work a Hybrid schedule to include 3 days in the office (Office located in Irvine, CA)

 

Preferred Qualifications:

Project management certification Provider office administrative or retail pharmacy experience Experience with Technology-based solutions (EHRs, IVR, Texting Applications, etc.)

 

The salary range for this role is $89,800 to $176,700 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

 

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.  

 

 

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.