Health Plan Operations Consultant - Warwick, RI - Full-time / Part-time

If you want to achieve more in your mission of health care, you have to be really smart about the business of health care. Challenge yourself, your peers and our industry by shaping what health care looks like and doing your life's best work.(sm)

The state of Rhode Island Executive Office of Health and Humans Services (EOHHS) is an innovative regulatory body that often develops programs which require new processes or process changes, reporting and analyses that have aggressive implementation timelines. In order to remain competitive, the RI Community & State Health Plan must implement these initiatives effectively and within prescribed deadlines/timelines.

We are looking for a Health Plan Operations Consultant who will be responsible for timely and effective project planning, implementation and performance of all business processes, programs and reporting the Health Plan is required to have in place under its Medicaid contract with RI EOHHS.

The Health Plan Operations Consultant is responsible for the development and implementation of programs designed for purposes of achieving the Health Plan's stated objectives and as required by its contract with the State of RI EOHHS. S/he is the primary liaison with other Health Plan and Corporate functions, as well as external/State constituents, on all issues related to contractually required programs.

Primary Responsibilities:

Required Qualifications:

• Undergraduate degree


• 5+ years of experience working with a managed care organization, health insurer, health organization or consultant in a project management role


• 5+ years of experience in data analysis and reporting


• Strong knowledge of business processes that impact managed care operations


• Ability to generate operations reports to meet business needs, working closely with other analytic teams in the organization to leverage internal expertise


• Ability to apply critical thinking to interpret reports and recommend improvements


• Ability to convey complex or technical information in a manner that others can understand including trend and outcomes


• Excellent communication skills, including ability to communicate effectively with various levels of leadership, internal and external/State constituents


• Advanced proficiency in MS Excel


• Intermediate proficiency in MS Access and MS PowerPoint

Preferred Qualifications:

• 
  

  Advanced degree



• 
  

  3+ years of project management or project lead experience



• 
  

  3+ years of experience managing or supervising staff (Note- this position may have supervisory responsibilities in future)



• 3+ years of experience with claims systems


• Proficiency in COGNOS; SMART (Microsoft)


• Care One reporting and operations experience (UHC Care Management system)

Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place 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, 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.

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

Job Keywords: Medicaid Program Manager, Managed Care, Operations Manager, Medicaid Project Manager, Healthcare Operations, Clinical Programs Administrator, Warwick, RI