DSNP Executive Director - Telecommute - Louisville, KY (112214529)
UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm)
The STATE DSNP will reach 10,000 members and revenue above $100 million, with expected growth in future years. Describe Medicare/Medicaid market landscape.
The selected individual will have P&L accountability in the market, demonstrated experience in leadership, strategic planning and organizational, operational and technical skills, and state customer relationship management. This individual directs the efforts to produce high-quality outcomes (including STARs), strategic leadership, financial outcomes, growth, and operational execution to serve vulnerable populations. The overall goal of this position is to provide executive oversight and leadership for UnitedHealthcare.
This role is expected to lead cross functional teams to deliver on revenue, membership, quality scores and outcomes, operating income objectives, develop key provider relationships, establish an influential relationship with the state, direct and effectively develop strategic goals into specific business plans, and create a successful, collaborative team of people to achieve these goals.
The role may involve selection, introduction and oversight of capitated/delegated entities caring for members. This includes performance against key business metrics such as STARs, member NPS, RAF scores, completion of health risk assessments, and effectiveness at avoiding unnecessary and/or inappropriate utilization.
The role will also need to collaborate closely with both the Medicare and Medicaid health plans in the market to meet state and federal policy objectives and requirements.
If you are located in Louisville, KY, you will have the flexibility to telecommute* as you take on some tough challenges.
Strategy & Growth:
- Develops, translates and executes the business strategy and growth strategy for the UnitedHealthcare Community & State KY DSNP
- Effectively develops strategic goals and turns those goals into specific operating and business plans
- Develop network contracting strategies, including the composition of the network and use of VBC arrangements
- Identify market-specific and/or regional priorities and determine the appropriate strategic approaches that will drive business growth and differentiate in the marketplace
- Deliver value to members by optimizing the member experience and maximizing member growth and retention
- Collaborate with Medicare health plan, the Medicaid health plan, capitatited providers, and with the State Medicaid agency, to meet state and federal policy goals and requirements to sustain the DSNP business
- P&L accountability for a 10,000+ membership and growing
- Work with capitated entities on risk-adjusted rates (HCC and RAF) to maximize revenue via coding
- Work with M&R and Optum financial teams around trends, reserving, tracking, affordability, chargebacks, and remediation
- Collaborates with the state partners to build long-lasting transparent and trusting relationships
- Leverage solid state relationships to position UnitedHealthcare as a trusted advisor to the state
- Represents UnitedHealthcare at external events and organizations; interacts with Community & State leaders
- Collaborates with network and other UHC lines of business in the State and surrounding markets to advance overall strategic objectives
- Collaborates with the Medicaid health plans to drive positive outcomes for members and providers
- Build, develop, improve, influence and expand relationships with key government sector customer groups, providers/provider networks and government/regulatory stakeholders within the market
- Continue positive working relationships with local sales teams and provide support to developing local broker relationships as requested
- Build positive working relationships with community partners in order to continue building brand awareness of UnitedHealthcare DSNP
- Drive oversight of, and collaboration with, the key shared services partners (e.g. Ops, UCS, UHN, OptumRx, M&R)
- Drive oversight of delegated entities that receives capitation from UHC
- Drive high-quality execution and operational excellence by communicating clear directions and expectations
- Develops operational protocols to verify effectiveness and compliance that exceed the expectations and commitments made to the State partners
- Partner with clinical vendors to review medical expense drivers and creates plans to reduce the waste and increase the affordability of our programs
- Play an active role in implementing innovation solutions by challenging the status quo and encouraging others to do so
- Develops and executes operational imperatives to support collaboration with Medicaid health plans and the State, including necessary data exchange; resolution of issues in joint operating committees; and analysis and reporting
- Manage execution by delegating work to maximize productivity, exceed goals and improve performance
Performance & Satisfaction:
- Drive sound and disciplined decisions that drive action while effectively using financial knowledge and data to manage the business
- Provides leadership to and is accountable for the customer satisfaction, provider satisfaction, financial and operational performance of the Health Plan
- Deliver best in class quality, operation and clinical performance
- Understand and manage multiple levels of profitability
- Analyze budget performance and variances throughout the fiscal year, and recommend and/or make necessary adjustments and corrections
Clinical outcomes/quality: Driven in partnership with Capitated Providers
- Lead the clinical and quality efforts to produce successful STARs results and improved clinical outcomes
- Exercise executive leadership over quality, clinical models and outcomes, including the Model of Care, transitions of care, effective interventions related to persistent super-utilizers and high-risk/high-need members
- Exercise executive leadership over the collaborative efforts with the Medicaid health plans around clinical data sharing, case conferences, collaboration, authorizations, and other strategies to produce high-quality outcomes in Medicaid and Medicare for members
- Lead and influence functional partners by fostering collaborative partnerships
- Influence and negotiate effectively to arrive at win-win solutions
- Communicate and present effectively, listen actively and attentively to others, and convey genuine interest
- Lead change and innovation by demonstrating emotional resilience, managing change by proactively communicating the case for change and promoting a culture that thrives on change
- Effectively represent the market in national and regional discussions/processes within UHC, including business planning and regular leadership meetings
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
- Bachelor’s degree or Equivalent experience
- 5+ years of experience in a Medicare/Medicaid
- 5+ years of experience in a senior leadership capacity
- 5+ years working in a matrix organization
- 3+ years of experience leading and managing people
- Experience in strategic planning and development
- Ability to execute to short and long term growth and profitability targets
- Master’s Degree (Business, Health Administration, Public Health, Social Work)
- Clinical and quality oversight experience
- P&L Management experience
- Presentation, public speaking and media skills
- Demonstrated Project Management skills
- Demonstrated successful leadership skills in program execution and people management
- Proven leadership skills in both internal and external environments
- Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation
To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment
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)
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy
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.