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Job Details


UnitedHealth Group

STARS Experience Leader-Government Programs Quality & Experience (106572463)

Government and Military

Government Programs

Yearly

No

Eden Prairie, Minnesota, United States

Optum 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 VP, Government Programs Quality & Experience leader will ensure that OptumRx clients achieve industry leading quality scores in the Medicare, Medicaid and Health Insurance Exchange lines of busines. Leveraging current regulatory and clinical guidance, industry best practices and OptumRx assets, this leader will be responsible for developing and executing on new strategies and advancing initiatives across cross functional teams within the PBM and pharmacy services to drive quality improvement, member experience and the analytics required to target care gap closure, enhance patient safety, and improve health equity.

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:
The VP of Government Programs, Quality & Experience is responsible for the strategic identification, design and programmatic implementation of quality improvement solutions for government programs business lines, including:

  • Program Development
    • Creation of value-add, ROI driven quality programs and services to support incremental revenue generation for the PBM, including value-based models which will improve PBM earnings opportunity
    • Accountable for measurable improvement of client quality measures year over year for delegated services through initiative identification, performance management and targeted analytics
    • Informing formulary strategy, product development opportunities and other benefit design elements leveraging industry guidance and best practices, evidence based clinical policy and data analytics
    • Collaborating with market, growth and cross functional leaders on shared opportunities including program and pricing development and with functional partners on external client opportunities
    • Responsible for having a comprehensive understanding of industry quality measures, complex regulatory guidance and clinical guidelines impacting quality scores to support best in class solutions, compliance, operational execution and client consultation, including where services are not delegated
    • Inform network design and pharmacy level value-based agreements for all government programs
  • Performance Management
    • Accountable for the enhancement of OptumRx’s predictive analytics toolkit to support advanced insights and action plans
    • Design and develop client and measure level dashboards and action plans, with measurable annual quality improvement goals
    • Leveraging voice of the customer, NPS, grievance, call center and other analytics and insights to scope the level of improvement required to impact customer experience and retention and develop corresponding initiatives to address
    • Direct and oversee enterprise wide HEDIS/QARR/HOS/CAHPS improvement and reporting
    • Direct operational and cross functional teams on the implementation of solutions to ensure that capabilities are scalable, repeatable and deliver on ROI/value expectations
    • Develops key performance measures upon which to evaluate solutions against market competitiveness and expectations, make modifications and drive continuous improvement
    • Seeks out and actively consults with external client customers on quality and member experience improvement opportunities with actionable feedback and recommendations
  • Team Development and Partnership Orientation
    • Establish a culture of collaboration, accountability and data driven, continuous quality improvement across shared services to deliver on our commitments
    • Deliver on talent management and job satisfaction within the team, inclusive of clearly defined successor for key roles


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.

Required Qualifications:

  • Bachelor’s degree
  • 10+ years of relevant industry managed care experience
  • Experience in Medicaid, Medicare and Health Insurance Exchange
  • Experience delivering results with cross-functional teams in highly matrixed organizations.
  • Experience managing and prioritizing multiple projects to ensure their quality and on-time delivery
  • Demonstrated healthcare industry knowledge, managed care quality principles for Medicare, Medicaid and Health Insurance Exchange
  • Full COVID-19 vaccination is an essential requirement 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

Preferred Qualifcations:

  • Graduate degree (MBA, MHA)
  • PharmD/RPH or other clinical degree
  • Consulting experience or experience leading broad and high visibility problem analysis and product solutioning with a diverse set of stakeholders.
  • Active relationships with external stakeholder groups/organizations that are oriented to healthcare, medical, social, policy, or other focal areas that are insightful for population health related products (e.g., NCQA, AHRQ, etc.)
  • Exceptional executive communication skills and proven ability to influencing thinking of C-Suite executives


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 with OptumRx. We're one of the largest and most innovative pharmacy benefits managers in the US, serving more than 12 million people nationwide. Here you’ll fill far more than prescriptions. As a member of one of our pharmacy teams, you’re empowered to be your best and do whatever it takes to help each customer. You'll find unrivaled support and training as well as a wealth of growth and development opportunities driven by your performance and limited only by your imagination. Join us. There's no better place to help people live healthier lives while doing your life's best work.(sm)

Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $134,200 to $257,700. The salary range for Connecticut / Nevada residents is $134,200 to $257,700. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

*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.

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