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Director of Clinical Implementation & Audit - Remote - Reside in Tennessee




Brentwood, Tennessee, United States

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us and start doing your life's best work.(sm)

The Director of Clinical Implementation & Audit is responsible for functions in areas across the health plan such as audit oversight, regulatory deliverables, provider relationship enhancement, vendor oversight, and quality clinical care delivery. This position includes activities that support program alignment with contractual requirements, monitoring, and preparation for quality review of multiple medical and clinical operations. Assumes accountability and ownership for many health plan deliverables, for example, Contract Risk Agreement (CRA) required reporting, On Request Reports (ORR), Request for Information (RFI), and/or others as applicable. Work is primarily at the operational or local business unit or market level. The Director will work with health plan leadership to lead the identification of areas of opportunity, risk, and support alignment of processes, and ensure policy/procedure consistency across the applicable department. This role will also provide direction and guidance in support of vendor activities which may include managing both new and existing vendor relationships.

If you are located in the state of Tennessee, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

  • Works with all areas of leadership across the health plan to identify priorities, areas of opportunity, and health plan compliance risk
  • Provides audit oversight and participates in audit activities for health plan
  • Develops and executes strategies with program leaders to create work plans, corrective action plans, and internal monitoring plans for areas of opportunity and risk
  • Provides oversight for compilation of information needed for state partner and health plan reporting including ORR, RFI, and/or other as applicable
  • Directs others to resolve business problems that affect multiple functions or disciplines
  • Develops, reviews, and updates policies for contractual alignment
  • Evaluates regulatory/contractual requirement changes and monitors the success of implementations
  • Identifies and implements business development opportunities to support growth
  • Evaluates compliance with Federal, State, and Local regulatory and organizational guidelines
  • Evaluates programs and services against accreditation standards, regulatory and organizational guidelines, as well as contractual requirements
  • Providers oversight for and direction to strategic partnerships team which includes management of provider and subcontractor vendor relationships
  • Perform other related functions as assigned

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 of higher in a health or business-related field
  • 5+ years of Managed Care Organization Experience or working interactions with Managed Care Organizations
  • 3+ years of Leadership Experience
  • Experience developing and implementing policies and procedures
  • Knowledge of health-care-related terminology, programs, and/or services
  • Proficient with relevant computer systems and platforms and ability to operate
  • Able to travel for on-site internal and external partner meetings (approximately biweekly in office meetings or in-state travel)
  • Reside in the state of Tennessee

Preferred Qualifications:

  • Master's degree in a health or business-related field
  • Experience with writing and submitting regulatory reports
  • Experience with and knowledge of the principles and practices of auditing, specifically with Medicare or Medicaid surveys
  • Understanding of relevant federal and state regulatory guidelines for compliance and program requirements
  • Understanding of applicable business departments' operations, drivers, and/or procedures
  • Understanding of and experience with vendor management/oversight
  • Knowledge of IT strategic sourcing, outsourcing, and contract development
  • Knowledge of Project Management, Certified Professional in Healthcare quality

Soft Skills:

  • Excellent interpersonal and communication skills
  • Ability to manage multiple complex concurrent project
  • Reporting skills and solid analytical skills
  • Ability to write clearly and help with word processing when necessary
  • Ability to communicate clearly with internal and external audiences
  • Ability to be flexible and work with ambiguity
  • Ability to self-direct work with solid problem-solving skills
  • Ability to multitask and prioritize
  • Ability to work collaboratively
  • Embrace a growth mindset
  • Highly motivated

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 employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

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.