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Job Details

UnitedHealth Group

Director, Healthcare Economics - Telecommute Anywhere in U.S.


Healthcare Network Director



Richardson, Texas, 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 is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm)

As the Director of Health Care Economics, you will lead analysis of payer and provider financial arrangements to include managed care contracts, value-based compensation, risk/capitation, and incentive pools as well as data integration activity on behalf of HCE. You’ll interact with senior leadership with a focus on performance to achieve business objectives. This is where your bold ideas will write the next chapter in health care.

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

Primary Responsibilities:

  • Manage the evaluation of payer proposals related to FFS, capitation arrangements and value-based contracts
  • Analyze provider reimbursement arrangements, including capitation, hospital, physician and ancillary contracts
  • Design and produce incentive pool calculations and reporting for our risk contracts inclusive of processing CMS revenue files, expense from various claims systems, and applying financial terms
  • Design and implement sound tools and applications to efficiently measure, monitor and forecast revenue from payers and expense trend for provider reimbursement
  • Serve as HCE liaison for national data integration activity as it relates to newly acquired entities as well as existing provider organizations
  • Encourage and promote idea generation in support of health care cost reduction strategies
  • Build strong relationships within the organization including financial, actuarial, network contracting and clinical operations areas

This position will serve as the leader for network and incentive analytics in the Optum Care HCE Northeast Region for network and incentive analytics as well as the HCE coordinator for data integration activity across new and existing Optum Care provider organizations. The Candidate should have demonstrated ability working within cross-functional teams and working with senior leadership. Successful candidates will have strong people, project, change and data management skills. Candidate should also have demonstrated ability to work in a matrix environment and lead through influence, as well as a history of improving results.

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 network pricing, healthcare finance and network analytics
  • 5+ years of experience with payor and provider contracting and value-based compensation programs along the risk continuum with a foundation of reimbursement methodologies, performance improvement and contracting support
  • 5+ years of experience utilizing detailed claims and CMS reimbursement methodologies (RVU, MSDRG, APC, SNF)
  • 3+ years of experience in evaluation and use of varying sources of data including data practice management data, other revenue cycle data (claims, encounters), capitation plan files and preferred experience in source to target mapping to a common data format
  • Intermediate proficiency working with query, business intelligence and statistical tools, include MS-SQL (writing, running and editing queries), SAS and Tableau
  • 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 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)

Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $113,500 to $218,100. The salary range for Connecticut / Nevada residents is $113,500 to $218,100. 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.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/AffirmativSe 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 bylower 48 law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.