Executive Director - M&R - Hartford, CT

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)

We have made a promise to the seniors we serve that we will support more effective care with networks focused on quality outcomes, a patient-centered clinical model and more members in high-quality rated plans - all delivered at the lowest medical costs and meeting and exceeding the expectations of CMS. The Executive Director is accountable for defining, leading and coordinating all local initiatives in assigned markets for improvement of CMS Star ratings, quality, coding accuracy and medical cost.

Primary Responsibilities:

• Actively coordinate with all Medicare & Retirement national functions (Product, Sales, Marketing, Member Experience, Finance), UnitedHealthcare shared services functions (Network, Clinical, Quality, Operations) and Optum (Local Care Delivery, HouseCalls, Complex Population Management) functions to leverage local market knowledge and establish and drive local tactical plans for improving CMS Star ratings, quality and coding accuracy in assigned markets


• Coordinate with Network and Optum teams to provide H-Plan Leads, Practice Performance Managers and embedded Practice Resources strategic direction; approve performance targets / metrics; ensure performance to targets.  Includes positive physician HEDIS run-rate performance; development and use of appropriate supporting tools (HouseCalls, CAHPS/HOS tools, documentation training)


• Partner with local health plan team, Network, Market Medical Director and Optum to increase HouseCalls completion rates and reduce refusal rates


• Drive all local quality and medical cost improvement initiatives


• Meet all assigned performance targets


• Maintain strong relationships with Medicare & Retirement national functions, UnitedHealthcare shared services functions and Optum businesses through regular communications and face to face contacts


• Exemplify and model Our United Culture and live our values with conviction

Required Qualifications:

• Bachelor's degree


• 5+ years of experience in a large, complex and successful health care / managed care organization with demonstrated track record of increasing responsibility and accountability


• In-depth experience with health care providers / networks, CMS Star ratings, HEDIS measures and clinical quality


• Demonstrated strong financial / analytical skills


• Strong written and verbal communication skills, including well-developed interpersonal skills used to influence the behavior of others across a highly-matrixed organization


• Demonstrated success building relationships with external executives and stakeholders


• Track record of meeting business goals via driving disciplined, fact-based decisions and executing with discipline and urgency


• Intermediate to Advanced skills with MS PowerPoint and Excel

Preferred Qualifications:

• Bachelor's degree in business, marketing, economics, health or public policy


• Master's degree


• Experience in a Medicare Advantage business

Careers at UnitedHealthcare Medicare & Retirement. The Boomer generation is the fastest growing market segment in health care. And we are the largest business in the nation dedicated to serving their unique health and well-being needs. Up for the challenge of a lifetime? Join a team of the best and the brightest to find bold new ways to proactively improve the health and quality of life of these 9 million customers. You'll find a wealth of dynamic opportunities to grow and develop as we work together to heal and strengthen our health care system. Ready? It's time 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: Medicare advantage, Medicare, Executive Director, CMS, government healthplans, Hartford, CT, Connecticut