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

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 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:Health Services LeadershipProvide strategic leadership and oversight for Health Services functions including Care Management, Disease Management, Utilization Management, and Transition of Care programsLead and develop multidisciplinary clinical teams, ensuring effective performance, engagement, and professional developmentEstablish departmental goals, monitor performance outcomes, and drive continuous improvement initiativesEnsure clinical programs support the health and well-being of statewide Medicaid membership across multiple programs and populationsCollaborate with operational and clinical leaders to align health services strategies with organizational priorities and contractual requirementsDrive initiatives that improve member experience, access to care, care coordination, quality outcomes, and health equityQuality Management & ImprovementProvide overall leadership for the health plan's Quality Management Program and Quality Improvement ProgramDevelop and execute comprehensive quality strategies aligned with state, federal, NCQA, and organizational requirementsOversee the development, implementation, monitoring, and evaluation of annual quality work plans and performance improvement initiativesLead efforts to improve HEDIS, CAHPS, Healthcare Effectiveness Data and Information Set (HEDIS), and other quality performance measuresDirect interventions to identify and close gaps in care while improving clinical outcomes and member engagementEstablish quality targets and oversee action plans to achieve performance goalsCoordinate quality improvement activities across clinical, provider, pharmacy, behavioral health, network, compliance, and member experience functionsRegulatory & Accreditation OversightEnsure compliance with Medicaid contractual requirements, state and federal regulations, NCQA standards, and accreditation requirementsOversee the preparation, maintenance, approval, and submission of quality program documentation, including:Quality Program DescriptionQuality Work PlanAnnual EvaluationPolicies and ProceduresPerformance Improvement Projects (PIPs)State-required reports and submissionsLead readiness activities and corrective action planning associated with audits, accreditation reviews, EQRO reviews, and state oversight activitiesMaintain effective quality governance structures, including quality committees and reporting processesStakeholder & Provider EngagementDevelop and maintain strong relationships with state regulators, Medicaid agencies, External Quality Review Organizations (EQROs), providers, and community partnersRepresent the health plan in quality and clinical discussions with state stakeholders and external partnersCollaborate with provider organizations to improve quality performance, member outcomes, and regulatory complianceServe as a strategic advisor and subject matter expert for quality and health services initiativesContribute to Request for Proposal (RFP) responses and support Medicaid procurement activities, particularly quality and clinical program sectionsLeadership & Organizational EffectivenessBuild, mentor, coach, and develop high-performing clinical and quality teamsFoster a culture of accountability, collaboration, innovation, and continuous improvementLead organizational change efforts related to clinical operations and quality performanceUtilize data, analytics, and performance insights to identify opportunities and drive strategic decision-makingPresent clinical and quality performance results to executive leadership, state agencies, and other key stakeholders 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:Current unrestricted Wisconsin RN license, or Wisconsin licensure in Social WorkBachelor's degree in Nursing, Healthcare Administration, Public Health, or related field, or equivalent experience8+ years of health plan or managed care experience5+ years of Medicaid managed care experience5+ years of leadership experience managing clinical and non-clinical staff5+ years of clinical practice experience in a hospital, clinic, home health, nursing facility, or related healthcare settingExperience in Care Management, Case Management, Disease Management, and/or Utilization ManagementExperience leading quality improvement programs and healthcare quality initiativesExperience with HEDIS, NCQA, quality measurement, performance improvement, and regulatory compliance programsDemonstrated ability to lead complex initiatives across matrixed organizationsSolid written, verbal, presentation, and relationship management skillsWisconsin residencyPreferred Qualifications:  Master's degree in Nursing, Healthcare Administration, Public Health, Business Administration, or related fieldCertified Professional in Healthcare Quality (CPHQ)Certified Case Manager (CCM)Experience supporting Wisconsin Medicaid programs and Long-Term Services and Supports (LTSS)Experience with state Medicaid agencies, EQROs, accreditation reviews, and governmental auditsExperience contributing to health plan strategy and affordability initiativesSolid change management, process improvement, and project management experienceExperience developing provider quality improvement partnershipsExpertise in healthcare quality, population health management, and value-based care strategiesDemonstrated success influencing executive stakeholders and external regulatorsSuccess Measures:Achievement of HEDIS, CAHPS, and state-defined quality targetsMaintain 'first in class' NCQA and STARS performance in the state of WisconsinImproved member health outcomes and care coordination performanceSuccessful completion of regulatory audits and accreditation reviewsCompliance with Medicaid contractual requirementsEnhanced member and provider satisfactionImproved operational efficiency and affordability outcomesDevelopment and retention of high-performing clinical and quality teamsSuccessful RFP submissions and wins for Family Care and Family Care Partnership *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 $159,300 - $273,200 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 help make the health system work better for everyone. Together, we are shaping the future of healthcare by harnessing technology and innovation to make care simpler to navigate, more affordable and more connected for the people we serve. We are committed to creating an inclusive workplace where everyone feels welcomed, valued, heard and respected, empowering people to bring their authentic selves to work and strengthening our collective impact through diverse talents, backgrounds, experiences and perspectives. UnitedHealth Group and its affiliated brands are 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 and its affiliated brands are a drug-free workplace. Candidates are required to pass a drug test before beginning employment.