Clinical Quality and Accreditation Manager – Hybrid in Southfield, MI

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.

 

The Clinical Quality Manager leads quality improvement initiatives focused on HEDIS, NCQA, and state performance measures. This role champions health plan quality by guiding care strategies and driving measurable improvements in outcomes. Manages new and ongoing projects within a population-based quality framework, aiming to close care gaps and enhance performance on key metrics. As a clinical subject matter expert, the manager collaborates across internal teams and external partners including providers and stakeholders, to implement member and provider facing interventions.

 

This role works cross-functionally with Clinical, Provider Engagement, Member Experience, Product, Compliance, Community Outreach, Behavioral Health, and Pharmacy teams to support continuous quality improvement.

 

If you are located in Southfield, MI, 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:

Strategic Leadership & Program Oversight

• Support health plan leadership in designing, implementing, and evaluating population health initiatives to improve care quality (e.g., HEDIS, CAHPS, HOS, etc.).
• Lead the development and execution of the annual LTSS Quality Program Description, Work Plan, and Year-End Evaluation
• Contribute to the health plan Quality Program Description, Work Plan and Year-End Evaluation
• Manage and coordinate quality improvement initiatives aligned with accreditation, regulatory, and business requirements
  

Accreditation & Compliance

• Maintain continuous readiness for NCQA accreditation, including Medicaid, LTSS, and Health Equity standards
• Ensure policies, procedures, and processes meet accreditation and regulatory requirements
• Support audits, reporting, and client-facing presentations related to quality and compliance

Performance Improvement & Data-Driven Strategy

• Facilitate performance improvement projects (PIPs) and workgroups using evidence-based methods and improvement science
• Monitor and analyze performance metrics (e.g., HEDIS, STARS), identify trends, and develop targeted interventions
• Document programs and evaluate effectiveness through data tracking and reporting
  

Cross-Functional Collaboration

• Act as a clinical subject matter expert across internal teams and external stakeholders, including providers and community partners
• Align efforts with Clinical, Case Management, Pharmacy, Behavioral Health, and Provider Engagement teams to improve care delivery and outcomes
  

Community Engagement & Health Education

• Develop and implement health promotion and member education programs to improve access and outcomes
• Serve as a liaison to community organizations, offering training and support to enhance member outreach and engagement

Provider Performance & Network Support

• Profile provider performance, identify underperformers, and coordinate improvement initiatives
• Collaborate with leadership on quality of care follow-up and provider engagement strategies
  

Documentation & Special Projects

• Develop and/or contribute to trilogy documents, committee materials, and population health/disparities plans
• Lead or support special projects and new program implementations as assigned
• This position will travel up to 25% of the time, throughout the state of Michigan and limited nationwide travel

Skills and Abilities:

• Self-directed, independent and track record of problem solving, initiation and leadership for extremely complex, visible and multifaceted topics
• Demonstrated ability leading across organizational silos when presented with highly complex and undefined work
• Ensure alignment and understanding of population scope and objectives with the organization’s strategic objectives and the Voice of the Customer, in consultation with all applicable stakeholders
• Ensure operational readiness through initiative oversight and continual monitoring for process improvement opportunities of population health strategies 
• Possess solid listening skills, demonstrated by high level of responsiveness and follow through
• Comfortable working through ambiguity toward clarity around data specifications and sources
• Demonstrated ability to analyze metrics, summarize key business learning, and translate into tactical plans and report to executive level management
• Demonstrated ability to influence non-direct reports, both internally and externally
• Demonstrated ability to make recommendations and implement quality improvement interventions based on results of projects. Converts data into useable information and measures the impact of improvement initiatives
• Knowledge of descriptive and inferential statistics
• Demonstrated ability to communicate ideas clearly and concisely at all levels (leadership)
• Demonstrated understanding of quality theory, data collection, analysis and study design; ability to track and display data; ability to design, implement and evaluate interventions required

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:

• Active and unrestricted RN license in the state of Michigan 
• 5+ years of professional experience in healthcare, public health, social services, education, or related fields
• Experience working with senior leadership and cross-functional teams
• Proven solid background in managed care, insurance, and quality improvement project management
• Hands-on experience with HEDIS, NCQA standards, and audit processes, including submissions to state and accrediting bodies
• Familiarity with External Quality Review Organizations (EQROs)
• Demonstrated ability to apply evidence-based quality improvement methods to reduce health disparities
• Proven leadership skills, including mentoring, motivating teams, and managing complex projects
• Solid community and stakeholder engagement experience
• Proficiency in Excel (including pivot tables), PowerPoint, and SharePoint
• Proven excellent analytical, problem-solving, organizational, and time management skills
• Proven solid written and verbal communication abilities
• Proven knowledge of change management principles, tools, and methodologies
• Experience in writing reports, analyzing performance data, and creating detailed documentation
• Driver’s License and access to reliable transportation and ability to travel up to 25%
• Resident of Michigan 

 

Preferred Qualifications: 

• Certified Professional in Healthcare Quality (CPHQ)
• Experience with Medicaid and/or Medicare programs.
• Solid knowledge of LTSS programs, HEDIS, NCQA standards, regulatory requirements, and the managed care industry
• Experience supporting members with complex care needs, including chronic and behavioral health conditions
• Familiarity with Health Information Exchanges (HIEs), Electronic Medical Records (EMRs), and practice management systems
• Proven ability to lead cross-functional teams through successful program implementations.
• Skilled in reviewing and interpreting managed care contracts
• Demonstrated ability to influence and engage stakeholders at all organizational levels
• Excellent communication skills, including verbal, written, presentation, and facilitation
• Solid conflict resolution, risk mitigation, and leadership influence capabilities

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

 

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $89,900 to $160,600 annually based on full-time employment. We comply with all minimum wage laws as applicable.

 

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.