Enterprise Clinical Performance is charged with supporting our OptumCare Care Delivery Organizations in achieving their tactical plans focused on delivering best in class clinical outcomes, de-escalating PMPM costs and driving toward MCG Well-Managed benchmarks where appropriate. The Enterprise VP Managed Care Clinical Services / Affordability will be responsible for leading the enterprise strategy around cost of care in partnership with operational and clinical leadership.
Lead a team of 10+ individuals, expected to grow over time
Provide Clinical Subject Matter Expertise and strategic direction, leadership and management for teams that drive clinical affordability programs and project implementations across OptumCare Care Delivery
Select and expand best practices for scalability across OptumCare Care Delivery while simultaneously striving for standardization and driving performance.
- Provide clinical thought leadership, subject matter expertise and strategic vision for clinical affordability initiatives, ensuring alignment with the OptumCare mission and vision.
- Oversee the Enterprise Clinical Performance Affordability team, supporting the development and delivery of tactical plans required to identify and deliver on base and incremental affordability opportunities
- Serve as secondary contact for the OptumCare Care Delivery Organizations and executive leadership for the Enterprise Clinical Performance Affordability portfolio for strategy discussions, tactical planning, project and program resource allocation and executive updates.
- Support leadership in defining robust business cases, securing resource approval and funding to deliver best in class clinical outcomes, de-escalate PMPM costs and drive toward MCG Well-Managed benchmarks where appropriate.
- Deliver initiatives supporting a variety of constructs (local, federated, enterprise) that aligns with our businesses and is chartered with improving the quality of care and achieving best in class clinical outcomes for our patients while achieving the quadruple aim.
- Provide strategic oversight of the business and financial plan for the Enterprise Clinical Performance Affordability portfolio and ensure the scope is delivered, the benefits are achieved and the medical expense reduction targets are met or exceeded; taking swift action and re-pivoting as needed to ensure delivery on the plan overall.
- Work in close collaboration with OptumCare providers and key partners to prioritize, plan, structure and implement Clinical Affordability initiatives on a national level for new acquisitions, as well as emerging and established markets.
- Contribute to the development of coordination of care initiatives; e.g., chronic condition management, utilization management, and case management that translates to strategies or functional/operational objectives at the segment level.
Build and maintain strong relationships with the OptumCare Care Delivery Organization’s clinical and operational leaders and across the UHG organization
- Lead activity designed to achieve goals that drive best in class clinical outcomes for our patients, improve patient and provider satisfaction while reducing overall medical expenses.
- Ensure compliance with all requirements (e.g., CMS, NCQA, Health Plan, state).
Critical Success Factors:
- Ability to effectively lead, manage and deliver in a fast pace, ever changing environment
- Ability to foster communications, robust collaboration and strong partnerships amongst OptumCare provider organizations, Enterprise Clinical Performance, key partners (e.g., HCE, IT, ES&P, Legal, Compliance), vendors and senior / executive leadership
- Proven ability to deliver results in a matrixed environment to effectively drive efficiencies, define / design / deliver solutions driving medical expense reductions while maintaining or improving outcomes
- Solid business, financial and technical acumen
- Strong problem-solving, negotiation and persuasion skills
- Bachelor’s degree in healthcare or administration
- 10+ years progressive leadership, portfolio management and presentation experience working with the C-Suite and all levels throughout the organization
- 10+ years of proven success in developing and leading strategy, high level tactical planning, and establishing and leading teams responsible end-to-end (strategy, design, develop, implement, ongoing process improvement) for large, complex initiative implementations spanning across multiple functional teams
- 7+ years working in a matrix environment with responsibility to drive efficiencies through influence and robust leadership, management and solid organization
- 5+ years of experience working in a provider organization
- 5+ years of experience with managed care in provider facing roles
- Working knowledge of quality and risk adjustment and deep knowledge of medical management with solid experience working in the following: STAR, RAF, Utilization Management (CM, DM, Pre-Service, Concurrent Review)
- Proficiency in Microsoft Power Point, Excel, Word, Outlook
- Strong written and verbal communication skills
- Proven experience managing organizational growth and change
- 30-50% travel
- Knowledge of Federal (e.g., CMS) and state laws and regulations relating to managed care (e.g., medical management)
- Knowledge of fiscal and human capital management techniques
- Six Sigma and PMP certification
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)
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.