No industry is moving faster than health care. And no organization is better positioned to lead health care forward. We need attention to every detail with an eye for the points no one has considered. The rewards for performance are significant. You'll help improve the health of millions. And you'll do your life's best work.(sm)
The health care markets are evolving in many different ways and the role and impact of the Medicaid is becoming increasingly important as health plans and providers look for new ways to grow and manage risk. In particular, the ability to manage medical cost through care management interventions or network management strategies is critical to the success of these organizations.
Optum is seeking a Decisions Rules Director to provide expertise in the Medicaid market. This position is responsible for the consulting solutions in all areas of Medicaid managed care products including, but not limited to, TANF, CHIP, LTSS, , Duals Population, , and provider sponsored organizations taking on risk for some of the most complex Medicaid populations.
You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
- Responsible for gathering business requirements, solution, design and testing of the decision rules for implementations.
- Direct responsibility for the oversight, hands on participation and delivery of large scale Medicaid consulting projects/programs; large scale programs are defined as high cost, high complexity and/or high risk
- Ensure utilization rate and billable revenues are attained annually
- Facilitate development of business segment and enterprise level planning and program objective setting
- Participate in program funding and prioritization decision processes
- Provide strategic input to the development of program roadmap and timelines
- Create a team oriented work climate that enables professional development and encourages creative solutions and strategies
- Support the management of resources within programs
- Support program communication plan and execution
- Require that quality assurance methods are implemented within the program
- Provide status updates and review of programs to senior leadership
- Provide coaching and mentoring of project team with the goal of developing and retaining talent within the organization
- Establish trusted partner relationships to expand the Payer Consulting footprint at designated clients
- Work with client to lay out strategic roadmap for consulting solutions
- Provide financial and data analysis to support ROI for project funding
- Obtains high client satisfaction scores (>90%)
- Develop and maintain clients references
- 8+ years of extensive Medicaid experience within a consulting or payer related organization
- 3+ years of experience with ODM and FICO Blaze business rules engines
- 5+ years of experience implementing Medicaid Health Plans
- 5+ years of experience with Medicaid claims, EDI, and Encounters
- Experience implementing cost savings solutions using business rules engines with Claims, Clinical or Enrollment applications
- 5+ years of experience in Management of Business Requirements, Data Analysis, System Integrated Testing and User Acceptance Testing.
- Ability to travel up to 80%
- Bachelor's degree
- Ability to create and execute SQL reports
- Knowledgeable in Medicaid Payer best practices
- Excellent presentation, writing and negotiation skills
- Experience with Agile Methodology
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)
*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/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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