Director - Healthcare Business Solutions - Boston, MA

MA LTSS (Long Term Services and Support) includes services that people with disabilities and chronic conditions use to meet their personal care and daily routine needs. LTSS are delivered in home, community and institutional settings across the care paradigm. It includes: adult day healthcare, durable medical equipment, personal care services, home healthcare and, physical therapy amongst other things. We would be providing TPA services to 176k with $3.2B in annual spend. MA’s goal is to reduce cost and improve outcomes. There are 2,546 LTSS providers for 16 service types.
 
This position will be responsible for providing business analysis and enabling technology support for MA LTSS TPA Contract and other new business initiatives while working closely with other functional leaders within the team and also other supporting organizations within Optum and UnitedHealth Group. We are looking for enthusiastic, energetic, accountable and seasoned individual with extensive hands-on experience in healthcare data analytics who is willing to work in a very dynamic environment and accept risks and rewards of a start-up, which includes a willingness to “roll-up their sleeves and pitch in where needed to meet all deliverables.”
 
Primary Responsibilities:


Work with MA LTSS Leadership and the client to develop program reporting and analytic strategies and lead the implementation

Lead the development of operational reporting to satisfy state and contract requirements

Lead the development of data analytics to identify additional opportunities to improve program quality

Lead the development of business intelligence to demonstrate program adherence to required SLA’s

Direct others to resolve business problems that affect multiple functions or disciplines

Provide clear direction for high complexity problems / issues

Provide directions in developing and maintaining operational policies and procedures

Responsible for ensuring business workflows are up-to-date and operationally efficient

Lead regular meetings with the client and internal/external stakeholders to review and discuss updates and outstanding issues

Responsible for developing and reviewing corrective action plans to address and/or resolve relevant internal and/or external stakeholders' concerns or issues regarding operational issues
Strategic Planning / Business Analysis


Lead requirements gathering, and document requirements specifications according to standard templates, using natural language simply, clearly, unambiguously, and concisely

Review, analyze and interpret contract and develop detailed business / technical requirements

Responsible for developing operational and clinical processes and identify technical solutions to deliver the outcomes
Provide Technical Solutions


Review the detailed requirements and develop technical solutions using various technology platforms such as salesforce.com and OpenSpan

Recommend improvements for operational process and IT system and implement the enhancements while working closely with other functional managers

Work with internal and/or external partners to interpret contractual requirements in order to ensure effective problem solution and strategy implementation

Provide leadership in conducting end-to-end testing of applicable processes, tools, procedures, and systems platforms to validate adherence to RFP / contract requirements

Work with internal partners to identify resource requirements and/or create budgets and forecasts

Required Qualifications:


Undergraduate degree

5+ years of business analysis, operations or project management experience

5+ years with business reporting, business intelligence

5+ years of experience in healthcare, preferably Medicaid and Long term services and supports

3+ years of data analysis and/or audit experience within the healthcare industry

Advanced level of proficiency in tracking, trending and reporting on metrics

Experience writing policies and procedures

Excellent verbal and written communication skills

Advanced level of proficiency with MS Word, Excel, PowerPoint, Visio 
Preferred Qualifications:


MBA degree or BA in Business

Experience with reporting and visualization tools such as Tableau

Salesforce and Pega / OpenSpan development experience
  
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care 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: 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.
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