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Job Details


UnitedHealth Group

Vice President, Regional Care Management - Torrance, CA

Healthcare

Acute Care

No

Torrance, California, United States

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

The Vice President of Care Management (CM) is responsible for establishing the strategic direction and successfully executing all Care Management activities for Optum CA. This person is responsible for planning, organizing, and directing the administration of all regulatory, delegated, and strategic care management programs. The VP provides oversight to ensure activities are appropriately integrated into strategic direction and operations, as well as the mission and values of the company. The position will be accountable for continuous process optimization and will provide support and leadership in the integration of Optum’s CM teams. The VP of Care Management will be an important part of the Optum CA Clinical Performance leadership team and work directly with Optum central and regional operations leaders, physician leadership, utilization management, contracting, finance, claims and compliance leadership to ensure compliant and high-performing CM process and outcomes. This position will also interface regularly with Optum’s Market and Provider Relations leadership teams to ensure excellent member and provider experience of care across Optum.

The VP maintains organizational structure and oversight of procedures, employment, training, and supervision of all Care Management staff. Directs long-term planning and communication regarding Care Management issues, and acts as a resource to all internal and external customers. The Vice President coordinates duties with appropriate personnel to meet operational program needs, ensures compliance with state and federal health plan requirements, Medicare guidelines, NCQA and URAC standards. The Vice President implements policy and procedures to maintain corporate and service initiatives. The Vice President integrates current clinical practice guidelines for care management services. The Vice President is also responsible for cultivating new leadership for the department.

Primary Responsibilities:

  • Leads the integration of Optum CA Care Management and serves as an innovative thought leader in the expansion of care management clinical programs to support quality, clinical outcomes, affordability initiatives, and compliance to better serve Optum members
  • Development, implementation and oversight of people, processes and technology required to engage with Optum California’s members using a population health approach to targeted member engagement
  • Responsible for scaling strategic enhancements to clinical program outcomes, interventions, compliance and financial value
  • Serves as an active thought leader and partner across the full clinical strategy and model of care for all Optum CA members, driving innovation across the clinical functions to improve performance and member outcomes
  • Actively collaborates with internal stakeholders and external partners, payers, and regulatory agencies to transform the health care experience for Optum customers and members
  • Develop and lead efforts to achieve financial performance consistent with division and market goals
  • Create the culture, systems, and processes that support consistent audit-readiness. Ensures internal audits are conducted, reviews results, formulates and implements appropriate action plans to correct any areas of noncompliance. Develop and oversee implementation of Corrective Action Plans as needed
  • Oversees and ensures that Care Management adheres to all regulations, contractual agreements, and applicable NCQA/URAC and other applicable accreditation standards. In addition, ensures adherence to other UM/CM/DM delegated agreement standards and expectations for all contracted health plans. Ensures internal audits are conducted, reviews results formulates, and implements appropriate action plans to correct any areas of noncompliance
  • Encourages Care Management staff to develop skills and knowledge for personal growth and promotion of position. Fosters leadership skills for supervisor positions to ensure most qualified staff performs management of processes. Promotes appropriateness in the utilization of staff by being flexible and assisting others when a staffing problem occurs. Identifies and helps develop future leaders
  • Actively participate as a key member of the Clinical Services Sr. Leadership team and in the development of policies, programs and initiatives that improve Employee Engagement, Diversity & Inclusion and Drive our Health Equity Goals
  • Performs additional duties as assigned

The information listed above is not comprehensive of all duties/responsibilities performed. This job description is not an employment agreement or contract. Management has the exclusive right to alter this job description at any time without notice


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
  • 7+ years of experience in managed care and/or care management with 10+ years of management level experience
  • Knowledge of federal and state laws and NCQA regulations relating to managed care, disease management, utilization management, discharge planning and complex care case management

Preferred Qualifications:

  • Master’s degree
  • 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

Professional Competencies:

  • Solid clinical leadership skills to ensure trust and respect of clinical staff
  • Solid operational mindset and ability to use data to draw insights
  • Solid ability to communicate in written and verbal presentations
  • Solid relationship development and team management skills
  • Results oriented, capable of clearly translating strategic objectives into implementation plans that drive outcomes
  • Success in driving organizational change and performance improvement
  • Solid collaboration skills to ensure effective alignment among diverse teams
  • Ability to excel in a matrixed environment

Work Environment:
The majority of work responsibilities are performed remotely or in an office setting, carrying out detailed work sitting at a desk/table and working on the computer. Travel will be required

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 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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