Manager, Clinical Quality & Value Based Programs

Opportunities with Colonial Healthcare, part of the Optum family of businesses. Join our team and advance your career within a leading primary care and specialty medical practice that prides itself on family-focused, patient-centric care. With over 25 years of experience, offices across Sumter, Columbia, Camden, and Manning, SC, and a commitment to reducing wait times and integrating cutting-edge medical advancements, we offer a supportive environment where you can grow professionally. Our dedication to improving the quality of life for our patients through coordinated care and advanced diagnostic services is unwavering. Be part of a network that values Caring. Connecting. Growing together. 

 

Colonial Healthcare is a growing multi-specialty healthcare organization committed to delivering compassionate and comprehensive care to patients across South Carolina.

 

The Manager, Clinical Quality & Value Based Programs is responsible for leading and supporting quality initiatives within the medical group, including the ongoing success of the Patient-Centered Medical Home (PCMH) model and value-based care. This role focuses on improving patient outcomes through patient-centered care, coordination of services, and quality improvement initiatives. Reporting to the Vice President of Operations, the Manager will work collaboratively with local and regional leaders, providers, patients, and community partners to ensure high-quality, patient-focused care.

 

Primary Responsibilities:

·       Oversees value-based quality performance improvement programs across Colonial Healthcare (HEDIS/Stars/PCMH/CAHPS/HOS/ACO/MIPS).

·       Oversees value based care risk adjustment execution and performance across Colonial Healthcare.

·       Oversees outreach strategy and informs the workflows, policies, and procedures that govern outreach to and engagement with patients that are due or overdue for annual visits and gaps-in-care.

·       Ensures compliance with and achievement against all full-risk and Pay for Performance (P4P) programs across Medicare, Commercial, and Medicaid lines of business.

·       Leads workflow development, data collection, health outcomes reporting, clinical audits, and annual submissions related to PCMH.

·       Coordinates continuity of care following hospital discharges and emergency department visits.

·       Coordinates high risk patient escalation and patient engagement with PCP to address high TCOC and high risk patient engagement initiatives in collaboration with clinical leadership

·       Ensures the timely submission of supplemental data to payors and seeks to automate data flows along with IT and Analytics, where possible.

·       Monitors historical and current data trends in quality to make recommendations for continuous improvement.

·       Leads a team that remains current on quality programs and measures.

·       Ensures compliance with HIPAA, corporate policies, and local, state, and federal regulations.

·       Coordinate and complete medical records requests for Colonial Healthcare

 

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: 

• High school diploma or equivalent
• Certified or licensed in medical related field (CMA, LPN, Radiologic Technologist, etc.)
• 5+ years previous supervisory and management experience 
• Experience with quality-based care/HEDIS
• Solid knowledge of chronic disease management and population health strategies
• Experience with electronic health records and disease registries
• Excellent communication, leadership, and organizational skills
• Ability to work collaboratively across interdisciplinary teams
• Driver’s License and access to reliable transportation with ability to travel 50% of the time to local clinics

 

Preferred Qualifications:

• 2+ years managerial experience in a medical group practice setting
• Proven ability to find, recognize, motivate, cultivate, and retain employee talent while creating a fair, accountable work environment

 
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 $71,200 to $127,200 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.