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　　Positions in this function are responsible for the development and/or on-going management and administration of clinical value programs and other clinical programs within Optum Care. The position provides support and measurement standards for a clinical model that incorporates applicable best practices with proven outcomes. The position will be required to work in a highly matrixed organization and will be focused on implementing value-based solutions in a diverse population of care providers.

　　You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

　　Primary Responsibilities:

　　Resolves highly complex business problems that affect clinical processes and functional requirements

　　As applicable, ensures local care delivery is in compliance with all payor, State, Federal, NCQA, and contractual requirements through implementation/recommendation of appropriate quality controls, checks and balances

　　Determines metric and baseline measures for medical management and process change outcomes / controls

　　Assists in the development of any required reporting and monitoring assessments in compliance with NCQA standards

　　Identifies operational reports, compliance reports, dashboards, and guides others on interventions and suggested improvements

　　Promotes regulatory compliance processes and change management on all assigned programs & initiatives

　　Participates in the development & maintenance of clinical policies, procedures, SOPs, Job Aids, reporting and assessment tools as applicable to clinical value programs

　　Prepares documents and reports for leadership reports, program status reports & compliance updates

　　Develops Executive level updates and reports

　　Participates in the development of measurable business and affordability goals

　　Identifies and prepares recommendations for cross-functional/cross CDO process improvements and opportunities

　　Identifies improvements in cross-functional communication process

　　Works with new and established CDOs ensuring medical management readiness to successfully enter into risk agreements

　　Identifies potential emerging customer needs and promotes innovative solutions to meet them

　　Solves unique and complex problems with broad impact on the business

　　Participates in the development of business strategy

　　Supports complex projects to achieve key business objectives

　　Translates highly complex concepts in ways that can be understood by a variety of audiences

　　Influences senior leadership to adopt new ideas, products, and/or approaches

　　Directs cross-functional and/or cross-segment teams

　　Supports all other Medical Management functions and duties as assigned

　　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:

　　3+ years of healthcare leadership / management experience

　　3+ years of experience in clinical consulting role, supporting various clinical affordability initiatives in large medical group setting or Health Plan

　　Experience in developing and executing strategies for functions or disciplines that span a large business unit or multiple markets/sites

　　Experience with directing others to resolve business problems

　　Experience in Population Health Management, Utilization Management, Case Management and/or Clinical Product Management

　　Experience with program development and management, including development of strategic initiatives, active implementation, post implementation management and execution

　　Experience in Medicare, Medicaid, and Commercial insurance

　　Broad understanding of Medicare, Medicaid regulatory requirements for Medical Management

　　Knowledge of NCQA, URAC, state & federal regulatory requirements

　　Knowledge of Utilization Management and Complex Case Management processes and performance metrics

　　Intermediate to advanced proficiency in Microsoft applications

　　Proven capability to work with people at multiple levels within an organization

　　Ability to travel up to 25%

　　Preferred Qualifications:

　　BSN or RN license

　　Undergraduate degree in Nursing, Healthcare Administration, or other Health related field

　　Experience working on high-profile issues with proven ability to bring to resolution

　　Proven solid team player with demonstrated interpersonal and customer service skills

　　California, Colorado, Connecticut , Hawaii, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The salary range for California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, or Washington residents is $88,000 to $173,200 annually. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

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

　　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 .

　　Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law .

　　OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.