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in Brentwood, TN

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Hours Full-time, Part-time
Location Brentwood, TN
Brentwood, Tennessee

About this job

Careers at UnitedHealth Group are anything but ordinary. We push ourselves and each other to find smarter solutions. The result is a culture of performance that's driving the health care industry forward. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Join us. And start doing your life's best work.(sm)
  
The Regional Director CCO provides leadership to and is accountable for the performance of teams in the assigned region deploying core services of the Patient Centered Care Model (PCCM) model, delivered for UHC populations and markets through community Care Coordination Organizations (CCO). 
 
CCO teams deliver model of care services to high cost high needs populations in Medicare and Commercial populations using Community Health Workers, RN Care Managers and Social Workers at the community level.  The Regional Director is accountable for overseeing and driving the overall outcomes and effectiveness of these initiatives through matrix partnerships in multiple states.  The Regional Director is responsible for ensuring assigned teams are staffed and deployed, work effectively and use data and appropriate technology to drive improvement in care coordination, care transitions, end to end referral management and meet population and triple aim goals: higher quality, lower costs of care and improved patient experience. The Regional Director collaborates with market leaders and CMOs and holds regular performance meetings with the CCOs to review progress and identify initiatives for improvement, including STARS improvement in Medicare.
This position reports to the National Director CCO within the Population Health division in United Clinical Services and is focused on Medicare and Commercial program deployment. Peers are Regional Directors deploying the program in Medicaid segments in assigned states and markets.
Primary Responsibilities:

The Regional Director develops policies, procedures, and guidelines for medical and clinical operations
Reviews / approve policy and process changes
Evaluates regulatory changes and determine steps needed to implement in programs
Develops medical and clinical operations program goals
Implements opportunities to support growth of medical and clinical operations programs
Oversees/navigates technology and software applications utilized in the delivery of CCO programs
Oversees management/service delivery systems utilized in member care
Contributes to and implements a business continuity plan to minimize interruptions to the business
Interprets compliance/clinical/medical reports
Evaluates compliance with Federal, State, and Local regulatory and organizational guidelines
Evaluates programs and services against state performance standards
Evaluate programs and services against CMS contractual requirements
Oversee monitoring and operations against relevant guidelines and standards
Implements continuous process improvement activities to ensure care is optimized
Measures employee/provider performance against internal procedures and protocols
Ensures Health Homes address gaps in performance against internal procedures and protocols
Develops and communicates performance metrics and expectations to Health Homes
Directs Clinical Operations data collection and measurement of outcomes
Applies metrics to evaluate services, employee performance, and program outcomes
Read and interpret reports (e.g., performance, service)
Identifies causes of performance deficiencies and determine appropriate follow up actions with team
Drives team implementation of best practices and standards
Develops operational budgets for medical and clinical operations
Evaluates staffing ratios, stratification of care, agency operations, to effectively manage business costs
Read financial reports, identifies reasons for financial performance gaps, and identify opportunities for improved financial performance and enhanced return on investment
Collects and reviews data to evaluate financial outcomes of programs and services
Conducts cost/benefit analysis on programs to drive efficiencies
Conduct competitive analysis and identify opportunities to enhance financial viability
Proposes and obtains approval for capital expenditures for needed medical and clinical operations
Collaborates with national, regional and health plan leaders and clinical program leaders to identify and effectively promote best in class strategies, and supports national clinical leaders in program development

Requirements


Required Qualifications:

Results driven leader with five years of experience leading population health strategies in Medicare and Commercial populations
Strong measurement and analytic focus
Record of success in driving affordability initiatives and inspiring teams to achieve process improvement
Experienced implementing strategies to integrate medical, behavioral and social support for complex patients
Experience leading Medicare STARS quality improvement initiatives
Effective in relationship building in a matrix management environment and negotiating solutions
Exceptional oral and written and presentation skills
Knowledge and experience implementing evidence based Care Transitions programs
Strong quality management experience including PDSA initiatives
Ability to organize and thrive in a fast-paced environment
Ability to travel in region 25%
Preferred Qualifications:

Master’s degree in epidemiology or public health
Experience implementing community based collaborative
Knowledge and experienced of CMS Innovation strategies and service delivery models
Knowledge of best practices in Medicaid nationally
Experience implementing behavioral health quality initiatives

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.(sm)

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer 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.

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