Clinical Quality Call Center Nurse Manager - Remote

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

The WellMed Quality Clinical Operations team supports WellMed Medical Management by delivering patient-centered, clinically collaborative medication consultations to help people live healthier lives. Our team focuses on the design, execution, and delivery of telephonic and digital engagement strategies designed to close STARs measure gaps in care, e.g. medication adherence, care for older adults, statins in patients with diabetes. Our interdisciplinary service delivery team is comprised of Pharmacists, Pharmacy Technicians, Licensed Vocational Nurses, and Care Coordinators.

The Clinical Quality Call Center Nurse Manager supervises and coordinates an existing team of supervisory leaders and strategic initiatives to ensure the delivery of STARs/HEDIS programs and services. The Nurse Manager works with management to support effective clinical operations and provides support to clinic staff in the absence of the Clinical Quality Call Center Supervisor. Will support the Quality Improvement Clinical Programs focused on STARs/HEDIS initiatives, including CAHPS/HOS, MRP, A1c, OMW, and other central initiatives. This role does not exist but there is a critical need for a higher level call center operations management skill set to ensure that WellMed maintains its historical 4+star ratings during a period of growth and expansion. Lack of this critical leadership role would put our goals, growth, and processes at risk and prevent us from achieving a 4+ Star performance.

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

Primary Responsibilities:

• Will have 15+ team members in their hierarchy, and provides coaching and assignment direction to supervisors to ensure staff complies with all regulatory initiatives and policies and procedures, while achieving performance targets
• May answer escalated calls from members and assists them with their inquiries
• Conducts performance reviews
• Supports leadership with presentation development and monitors metrics ensuring target goals are met for STAR performance
• Adapts departmental plans and priorities to address business and operational challenges
• Influences or provides input to forecasting and planning activities
• Product, service or process decisions are most likely to impact multiple groups of employees and/or customers (internal or external)
• Participates in and contributes to the overall clinical quality improvement initiatives
• Performs all other related duties as assigned

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:

• Undergraduate degree or equivalent experience
• 5+ years of Managerial experience preferably in a health care setting
• Extensive knowledge of the Medicare Part D, particularly the pharmacy record review, claims, billing and reimbursement rules
• Working knowledge of HIPAA Privacy and Security Rules and CMS security requirements
• Working knowledge of Microsoft Office, Internet and e-mail
• Prior work in STARS and clinical Medicare Part C gap in care closures
• Demonstrated general writing skills and ability to produce work free from typographical or spelling errors

Preferred Qualifications:

• Master degree or equivalent experience
• PBM experience
• Call center experience
• Bilingual

Physical & Mental Requirements:

• Ability to lift up to 25 pounds
• Ability to sit for extended periods of time
• Ability to use fine motor skills to operate office equipment and/or machinery
• Ability to receive and comprehend instructions verbally and/or in writing
• Ability to use logical reasoning for simple and complex problem solving

*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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.