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Director Analytics and Operations - Remote


Medical Director


Tampa, Florida, United States

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm)

ECP is charged with effectively implementing, monitoring, and executing on risk and quality programs with a special focus on Risk Adjustment. CP operates on a national level by providing support in all markets served by Optum Health.

The National Director for Enterprise Clinical Performance Clinical Documentation Review will be responsible for implementation, execution, and tracking on operational and analytics initiative’s focusing on Risk Adjustment and Quality via clinical documentation reviews throughout Optum Health. This position will report into the Enterprise Clinical Performance’s Clinical and Coding Intelligence Pillar’s Senior Medical Director and will be responsible for developing relationships and driving operational implementation and analytics around clinical and coding reviews.

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

Primary Responsibilities:

  • Work in close collaborative partnership with the national markets, as well as the Clinical Performance Senior Director and Medical Director and team to plan, organize and implement risk and quality processes and analytics on a national level
  • Provide solid leadership for initiatives such as market implementation, chart review and analytic processes
  • Assure flawless operations and execution for Clinical and Coding Intelligence to ensure processes are completed timely in accordance with company objectives
  • Monitor and track actual versus expected performance to target areas for improvement
  • Analyze, identify root cause, and support remediation if needed for projects and areas of focus within CP
  • Drive Compliance with all applicable local, state and federal laws and compliance programs
  • Strive to improve operational efficiencies and make recommendations as appropriate; take ownership of process as assigned and provide constructive information to minimize problems and increase provider and market satisfaction
  • Partner with leadership teams and management across markets to coordinate execution and implementation in Optum Health

Aggregation, Implementation, and Support of:

  • Quality Initiatives:
    • Gaps in care
  • Risk Adjustment Initiatives:
    • Clinical and Coding Reviews / Audits
    • Best practices for engagement
  • Training programs
  • Compliance programs

Critical Success Factors:

  • Working in a matrix environment to drive efficiencies through influence
  • Seeks ways to improve job and operational efficiency and makes suggestions as appropriate
  • Takes ownership of the total CP process and provides constructive information to minimize problems and increase provider and market satisfaction
  • Partners with leadership teams and Optum management across markets to coordinate execution and implementation in all markets
  • Ensure activities are appropriately integrated into the strategic direction, as well as the mission and values of the company

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 or greater or equivalent experience
  • 5+ years combined experience within managed care/health insurance industry experience
  • 5+ years of data analysis, process documentation, and/or process improvement experience
  • 5+ years of experience interacting with business leadership
  • Experience working with multiple levels and departments organizationally to accomplish defined objectives
  • Intermediate proficiency with Microsoft Excel, PowerPoint, Word
  • Lead a complex or multifunctional/multi-location team/organization
  • 10% travel

Preferred Qualifications:

  • 5+ years of previous experience in Program Management
  • 3+ years of experience in risk adjustment
  • Experience in Quality with a working knowledge of HEDIS a plus
  • Proven experience managing organizational growth and change
  • Solid knowledge of CMS Risk Adjustment and ICD-10 coding requirements and regulations
  • Solid knowledge of CMS Risk Adjustment and ICD coding requirements and regulations
  • Familiarity with government pay for performance programs a plus
  • Proficiency with Microsoft Office
  • Lead a complex or multifunctional/multi-location team/organization
  • Demonstrates well-honed communication skills (both written and verbal)
  • Proven ability to build strong relationships across a variety of stakeholders

Careers at OptumCare. We're on a mission to change the face of health care. As the largest health and wellness business in the US, we help 58 million people navigate the health care system, finance their health care needs and achieve their health and well-being goals. Fortunately, we have a team of the best and brightest minds on the planet to make it happen. Together we're creating the most innovative ideas and comprehensive strategies to help heal the health care system and create a brighter future for us all. Join us and learn why there is no better place to do your life's best work.(sm)

OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare’s support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.

California, Colorado, Connecticut, Nevada, New York, Rhode Island, or Washington Residents Only: The salary range for California, Colorado, Connecticut, Nevada, New York, Rhode Island or Washington residents is $118,000 to $226,800. 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 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: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.

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