Associate Director-Healthplan Ops-Health Home-Seattle, WA

The Health Plan Medicaid Operations Director will be directly responsible for the performance of the both the Person Centered Care Management (PCCM) and Transitional Case Management (TCM) clinical programs. The programs support Medicaid and Dual consumers.   In addition, the Operations Director will be accountable to coordinate between the health plan and other linked Optum programs.   This person will be accountable for identifying and driving affordability opportunities at the Health Plan level. The person in this role will be the primary liaison between the C&S Health Plan, Optum clinical programs, and Optum Product to provide a continuous feedback loop regarding program performance and State needs.  This includes supporting RFPs, Health Plan specific requests to adapt current programs to respond to state compliance requirements/mandates and continuous improvement projects to support affordability goals

The ideal candidate will provide strategic and tactical direction to the operational team. Oversight would include teams doing telephonic and field based work.

This role works closely with the Community & State Health Plans as well as Optum Product Team, to make design recommendations and support implementation of Clinical Management solutions for the Medicaid customer.  The scope of the position leverages in-depth quantitative skills, knowledge of the unique needs of the Medicaid/DSNP membership, Optum operational capabilities, and an understanding of key business objectives.

Primary Responsibilities:

• Primary Optum Clinical Programs Operational Leader for the health plan


• Direct all Operational activity for the PCCM and TCM programs


• Build strong relationships with key C&S Health Plan clinical leaders


• Responsible for ensuring the reporting of program metrics


• Lead innovation by proactively making recommendations on program design as needed to ensure program performance at or exceeding set targets


• Working across other functional areas (operations, reporting, analytics, finance, product etc.) to support the execution of the program strategy


• Coordinate with other Optum programs such as Specialty Networks (Behavioral, Complex Medical Conditions, Physical Health) and Complex Population Management as needed


• Support implementation of PCCM model within the Health Plan per national implementation schedule


• Work with reporting and operations to monitor Optum performance at the Health Plan level. Present results at Monthly Business Review with Regional Plan leads


• Make operational adjustments to ensure programs are performing at or exceeding set targets


• Drive affordability within the Health Plan; participating in affordability reviews and action planning for the Acute Medicaid and DSNP membership


• Partner on all custom/non-standard requests made by the Health Plan, collaborating on the governance process designed to address which actions will be carried out and by when


• Represent care management programs during state audits


• Supports the team to ensure compliance with state regulatory requirements, quality and HEDIS standards and ISO compliancy


• Other duties as assigned by management
  

Required Qualifications:

• This position is located in the Plan specific market


• Demonstrated ability to prioritize deliverables


• Proven organizational skills with ability to be flexible and work with ambiguity


• Ability to think and act strategically and as well as execute tactically with bias toward action


• Baseline financial acumen and the ability to use data in directing and prioritizing work


• Understanding and use of business process improvement and re-engineering concepts


• Excellent analytical skills


• Excellent verbal and written communication skills


• Ability to work in a virtual team environment


• Experience with Microsoft Excel, PowerPoint, and Word


• Bachelor's Degree, Masters in business, or health care field

Preferred Qualifications:

• Public sector experience


• 5+ years health plan and/ or clinical care management operational experience


• Experience working within a matrix organization


• Clinical background

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability status.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.