Senior Director, Prior Authorization and Clinical Affordability - Telecommute (106956606)
UnitedHealthcare 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 Senior Director of Coverage Discipline will report to the VP of Affordability and has responsibility for the clinical and reimbursement policy strategy and execution, identifying and implementing new clinical affordability strategies and governing existing prior authorization partnerships. This includes driving a large portion of the $160M clinical affordability target for C&S (incremental new value), as well as governing program administrative spend in excess of $100M. This role will be accountable for overseeing Utilization Management strategic initiatives such as UM modernization, Decisioning at Point of Care and mental health parity. It will be responsible for improving the consumer and provider experience in one of the most common and negatively perceived health plan touch points. It requires cross functional leadership with healthcare economics, actuarial, finance, UHN, UCS and ECS partners. This role requires the ability to build trusting relationships with health plans and the ability to drive business goals with sister departments in UHC and Optum. The Sr. Director of Prior Authorization and Clinical Affordability must understand how to drive complex business strategies and processes throughout and across our matrix organization.
Results are critical to this leader's success, as is a personal alignment with UHC's mission to help people live healthier lives and the core belief that an organization can manage cost and deliver quality and value to its customers. In total, C&S serves over eight million members across the United States and the District of Columbia.
You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Strategic Program Management
- Partners with UCS to ensure UM Modernization is executed on-time and has health, experience, cost and equity benefits that flow through to the business
- Represents C&S in UHC-wide medical policy refresh
- Develops new UM capabilities based on market needs and/or performance gaps
- Responsible for the design, development, management or sun-setting of new or existing UM programs.
- Defines short and long term coverage discipline roadmaps
- Collaborates with stakeholders to obtain input and buy-in to program strategies (e.g., Clinical, HCE, Finance, Health Plan, Non-Clinical Operations, Legal)
- Partners with Information Technology to ensure necessary technology and automation are available to support program delivery
- Manages UM program portfolio to improve competitive position and optimal performance. May work with internal or external business constituents.
- Develops and communicates performance metrics and expectations to ECS, UCS and external vendors
- Establishes reporting, data and analytics to monitor UM affordability program performance
- Monitors and leverages key reports and tools to manage against financial goals; communicates trends and performance improvement plans to executive leadership
- Evaluates quality, affordability, and operational results with shared set of metrics and holds shared services accountable
- Identifies causes of performance deficiencies and determine appropriate follow up actions
- Drives implementation of best practices and standards across health plans
- Conduct cost/benefit analysis on programs to drive efficiencies and to identify opportunities for enhanced return on investment
- Leads and drives large scale initiatives, assists with program governance and manages interdependencies
- Develops, translates and executes strategies or functional/operational objectives
- Ensures organizational alignment: works across business to ensure alignment across regions and across matrix partners
- Owns UM/policy status reports to Executive Leadership Team (ELT); directly engages with and influences ELT to drive key decisions and resource allocation
- Executes against strategic, tactical, and operational goals in partnership with market and regional leadership and cross-functional partners.
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.
- BA required or equivalent experience
- 10+ years healthcare or related industry experience
- 7+ years of demonstrated progressive career accomplishments
- 7+ years strategic management of complex products/processes/scope of accountability
- 7+ years leadership experience (direct or indirect reporting relationships)
- 7 + years business operations and execution experience with the ability to quickly diagnose and solve complex problems
- Demonstrated leadership and hands-on experience, strong leader and motivator with the ability to develop talent within the organization
- Demonstrated planning, project management and communication skills. Accurately scopes out projects, sets objectives and goals, develops schedules and resource assignments, measures performance against goals, and evaluates results
- Ability to deal with ambiguity - can cope with change, can shift gears comfortably, comfortably handles risk and uncertainty in a manner consistent with UnitedHealth Group’s core values
- Advanced Degree
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 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)
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/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.