Health Services, Population Health & Quality Director - Remote in Wisconsin

Job d:

Location:

Milwaukee, Wisconsin, United States Salary: $159,300 - $273,200/year

Job Area:
Medical & Clinical Operations Company:
United Health Group At United Healthcare, 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 optimized. Ready to make a difference? Join us in making healthcare work better for everyone through people-led, responsible AI while Caring.

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The Health Services & Quality Director provides strategic leadership, direction, and oversight for the Health Services, Care Management, Utilization Management, and Clinical Quality functions for the Wisconsin Medicaid health plan. This role is accountable for ensuring high-quality, member-centered care while driving clinical excellence, regulatory compliance, quality performance, and population health outcomes across all Medicaid programs.

Working in a highly matrixed environment, the Director develops and executes integrated clinical and quality strategies that improve member outcomes, support affordability goals, enhance provider performance, and ensure compliance with state, federal, NCQA and accreditation requirements. The role serves as a key leader within the health plan and collaborates closely with executive leadership, state agencies, providers, and enterprise partners to advance the organization's quality, service, and operational objectives.

Populations include Badger Care, SSI, Childless Adults, Family Care and Family Care Partnership.

If you are located in Wisconsin, you will have the flexibility to work remotely
* as you take on some tough challenges.

Primary Responsibilities:

Health Services Leadership Provide strategic leadership and oversight for Health Services functions including Care Management, Disease Management, Utilization Management, and Transition of Care programs

Lead and develop multidisciplinary clinical teams, ensuring effective performance, engagement, and professional development

Establish departmental goals, monitor performance outcomes, and drive continuous improvement initiatives

Ensure clinical programs support the health and well-being of statewide Medicaid membership across multiple programs and populations

Collaborate with operational and clinical leaders to align health services strategies with organizational priorities and contractual requirements

Drive initiatives that improve member experience, access to care, care coordination, quality outcomes, and health equity

Quality Management & Improvement Provide overall leadership for the health plan's Quality Management Program and Quality Improvement Program Develop and execute comprehensive quality strategies aligned with state, federal, NCQA, and organizational requirements

Oversee the development, implementation, monitoring, and evaluation of annual quality work plans and performance improvement initiatives

Lead efforts to improve HEDIS, CAHPS, Healthcare Effectiveness Data and Information Set (HEDIS), and other quality performance measures

Direct interventions to identify and close gaps in care while improving clinical outcomes and member engagement

Establish quality targets and oversee action plans to achieve performance goals

Coordinate quality improvement activities across clinical, provider, pharmacy, behavioral health, network, compliance, and member experience functions

Regulatory & Accreditation Oversight Ensure compliance with Medicaid contractual requirements, state and federal regulations, NCQA standards, and accreditation requirements

Oversee the preparation, maintenance, approval, and submission of quality program documentation, including:

Quality Program Description Quality Work Plan Annual Evaluation Policies and Procedures Performance Improvement Projects (PIPs)
State-required reports and submissions

Lead readiness activities and corrective action planning associated with audits, accreditation reviews, EQRO reviews, and state oversight activities

Maintain effective quality governance structures, including quality committees and reporting processes

Stakeholder & Provider Engagement Develop and maintain strong relationships with state regulators, Medicaid agencies, External Quality Review Organizations (EQROs), providers, and community partners

Represent the health plan in quality and clinical discussions with state…