Director Operations, Virginia Long Term Services & Support - MLTSS - Richmond, VA

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Operations Director, Virginia Long Term Services & Support (LTSS)

The MLTSS Operations Director manages daily operations of multiple levels of staff and multiple functions/departments across UnitedHealthcare to meet performance requirements. The MLTSS Operations Director is empowered to make decisions about MLTSS Program issues and represent UnitedHealthcare at the Department’s meetings. This position is responsible for responding to issues involving information systems and reporting, appeals, quality improvement, member services, service management, pharmacy management, medical management, care coordination, and issues related to the health, safety and welfare of the member.

Principal Duties and Responsibilities:

Plans/implements and manages operations programs and strategies
Supports, develops and validates compliance with operations policies, procedures and regulations
Reviews, manages and drives operations efficiency, quality and financial performance
Sets business direction, develops, implements and oversees operational models to meet the unique needs and business requirements for UnitedHealthcare
Verifies improvements and operations are evaluated based upon appropriate quantitative and qualitative measures
Develops collaborative relationships with and confirms business partners can execute day-to-day responsibility for operations (member services center, enrollment, technology, network, etc.).
Informs and advises management regarding Commonwealth current trends, problems and activities to facilitate both short- and long-range strategic plans to improve operational performance and enhance growth
Owns end-to-end process improvement: definition of need, project plans, status updates, reporting and achieving results
Identifies/resolves technical, operational and organizational problems inside/outside of UnitedHealthcare
Confirms all operational activities conform to contract compliance for all programs
Understands and manages the Commonwealth requirements and relationships related to operations
Co-leads business executive team with primary responsibility to build the organizational support and infrastructure to translate business vision and strategy into operational tactics
Establishes business metrics required to meet state partner, member and care provider requirements
Coordinates the tracking and submission of all contract deliverables
Coordinates the preparation and execution of contract requirements such as random and periodic audits and ad hoc visits
Coordinates the preparation and execution of policy development and annual review process
Assesses operating business risks/opportunities and identifies strategies to mitigate/capitalize as appropriate
Works with the compliance officer to provide interpretation and education to UnitedHealthcare on contract, rules and regulations
Facilitates and cooperatively manages new law implementation with the business
Provides consultative expertise/guidance and promotes compliance with laws and regulations with business partners ensuring effective response to changing laws
Answers questions and inquiries from functional areas; satisfies requests for research related to specific legislation/regulations
Identifies issues for resolution and works closely with compliance functional areas and cross-functional/cross segment departments as necessary to resolve issues
Anticipates and pushes change through the organization, equipping staff to adapt quickly
Facilitates holistic thinking/innovative problem solving and integrates efforts/results
Structures business disciplines to facilitate quick and data-based decisions and ensures accountability for execution
Evaluates outcomes based upon qualitative and quantitative measures and adjusts according
 

Bachelor’s degree required
A minimum of 10 years of related managed care experience is required
7+ years of people management experience required
Knowledge of and experience related to publicly funded government health care programs (e.g., Medicaid, Medicare or Commonwealth health care programs for the uninsured
Operations experience in Medicaid/Medicare/government health care program administration
Technical and financial understanding of health care operations
Strong leadership and business planning skills within a matrix environment
Ability to communicate clearly with internal partners and external regulatory agencies and effectively represent UnitedHealthcare’s interests.
 Must live or be willing to relocate to Richmond, VA areaCareers 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: 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.
 
Key words: LTSS; Long Term Services and Support; Richmond, Virginia; Richmond, VA; Long Term Care; LTC; Medicaid; Medicare; Government Healthplans; Operations Director