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We have modest goals: Improve the lives of others. Change the landscape of health care forever. Leave the world a better place than we found it. Such aspirations tend to attract a certain type of person. Crazy talented. Compassionate. Driven. To these individuals, we offer the global reach, resources and can-do culture of a Fortune 5 company. We provide an environment where you’re empowered to be your best. We encourage you to take risks and in return, offer a world of rewards and benefits for performance. Exceeding your limits is an exceptional start to your life's best work.SM


Just like you, we are driven by a set of fundamental principles that are guiding our way forward. Our values of integrity, compassion, relationships, innovation, and performance serve as a foundation to transform health care. Are you in? Learn more about your future at UnitedHealth Group at careers.unitedhealthgroup.com


Job Category:

Business Operations



Approximate Salary:

Not Specified

Position Type:

Full Time

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Director, Clinical & Quality Solutions - Telecommute

UHG - Eden Prairie, Minnesota

Posted: 10/30/2018

Within our Risk Adjustment and Quality business in OptumInsight we are seeking a strong expert in the space to help the business grow and achieve its long term strategies. In this role, the expectation is to provide leadership, management and vision to effectively grow the organization and to ensure financial strength, while designing solutions to fit our customer’s needs. This individual will have either come from a Payer working in this space or Risk Adjustment & Quality service provider and have intimate knowledge and expertise. The individual will represent the business both externally and internally and architect solutions to meet our client’s needs. The candidate will have to have a strong expertise in the Medicare Advantage and ACA Market, expertise in healthcare economics and an ability to strategically shape solutions that meet client objectives and can be delivered successfully.


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

Primary Responsibilities

  • Ability to operate inside a matrix organization, sales, operations, product, pricing etc.
  • Architect solutions for customers
  • Drive revenue goals
  • Lead contract negotiation
  • Revenue goal responsibilities (budgets and actual)
  • Build/Operate a team of solution architects and the ability to create standardization within that process
  • Develops and leads functional strategy, plans, and organizational priorities
  • Responsible for driving the organization to achieve and surpass sales, profitability, business goals and objectives
  • Development and execution of growth strategy
  • Involved with the sales to achieve quarterly and annual results
  • Lead the development, communication and implementation of effective growth strategies and processes
  • Collaborate cross-functional area to develop and implement plans to support the rapid growth objectives

Required Qualifications

  • Undergraduate degree
  • 4+ years of Risk Adjustment Expertise- both Retrospective and Prospective
  • 4+ years of Quality/HEDIS Expertise- both software and Medical Record Review
  • Responsible for financial impact of risk adjustment and quality for a health plan
  • Payer expertise with a focus on MA and ACA populations
  • Health plan experience
  • Ability to travel 30%

Preferred Qualifications

  • MBA
  • P & L experience

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.



Job key words: Director, Clinical & Quality Solutions, Telecommute, Telecommuting, Telecommuter

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