Quality Improvement Operations Manager - Remote

Optum
US - California - El Segundo
January 18, 2025

For those who want to invent the future of health care, here's your opportunity.
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This position is responsible for the day-to-day management of non-clinical staff (QI Coordinators) within the Grievance/ Peer Review Lane of the Optum CA Quality Improvement Department.
The role reports directly to the Senior Director of Quality Improvement and collaborates with QI Managers and clinical staff (QI Nurses) to manage health plan grievance and potential quality issue case productivity, turn-around-times and quality.

You'll enjoy the flexibility to work remotely
• from anywhere within the U.S.
as you take on some tough challenges.

Primary Responsibilities:

Manages a team of Quality Improvement (QI) Coordinators responsible for the intake and processing of health plan grievances and potential quality issues
Reviews the work of direct reports; including initial reviews, documentation, query letters, response letters and health plan submissions to ensure compliance with established processes and workflows
Assists on resolving escalations including responding to health plan corrective action plans
Uses QI databases, tracking tools, and other relevant software for quality improvement and grievance management
Devises productivity management strategies to complete grievances and PQIs within turnaround time expectations
Partners with QI Analyst and Nurse Managers to devise and deploy productivity monitoring and trend work output of grievances over time
Monitors productivity of direct reports, organizes and leads team meetings to ensure team alignment on goals and processes
Assists with developing, documentation, and training to new QI processes and workflows
Prioritizes tasks effectively and manages multiple responsibilities to ensure efficient department operations

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 with Appeals and Grievances, Claims or Health Plan Customer Service
2+ years of experience managing work inventory to compliance metrics
2+ years of experience direct supervisor experience in managing or coordinating teams

Preferred Qualifications:

Demonstrated experience in developing and implementing workflows and processes, especially in transitioning to new systems, such as grievance databases
Experience with Case Management, Inpatient or Ambulatory care settings
Knowledge of health plan turnaround times and commitment to meeting or exceeding performance metrics
Proficient in learning, adapting to, and implementing new systems and technologies
Proficiency in Excel
Proven comfortable with using databases, tracking tools, and other relevant software for quality improvement and grievance management
Proven skilled in creating and optimizing workflows to enhance team productivity and effectiveness

• All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

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.

Application Deadline:
This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected.
Job posting may come down early due to volume of applicants.

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

Read the full job description and apply online on the recuiter's web-site

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