Health Services, Population Health & Quality Director - Remote

Improve the lives of others while Caring. Connecting. Growing together.

Job Description
- Health Services, Population Health & Quality Director
- Remote in Wisconsin (2394111)

Health Services, Population Health & Quality Director
- Remote in Wisconsin - 2394111

At United Health Group, 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.

Connecting. Growing together.

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:

• 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,…