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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:

Medical and Clinical Operations



Approximate Salary:

Not Specified

Position Type:

Full Time

VP Dental Clinical Operations - UHC

UHG - Eden Prairie, Minnesota

Posted: 12/17/2018

The Vice President of Dental Clinical Operations is a key member of the UnitedHealthcare Clinical Services Team with direct dental utilization management and clinical programs accountability for a national dental organization serving over 12 million members.  Products and networks include DPPO, DHMO, D-INO, Discount, and Medicaid Dental plans underwritten through a variety of integrated and dental-focused legal entities.
This individual will serve as the leader of the UnitedHealthcare Clinical Services dental program supporting the UnitedHealthcare Specialty Benefits Organization.   Additionally, this leader will understand how to drive complex business processes throughout a matrix organization. Results are critical to this leader's success, as is a personal alignment with UHC’s core belief that an organization can manage cost and deliver quality and value to its customers.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
  • Responsible for the oversight of system wide clinical operations, including Utilization Management, Quality Management, Appeals & Grievances and Clinical Quality Programs.
  • Collaborates with the Specialty Benefits, Chief Executive officer and Chief Dental Officer to support the development of a comprehensive clinical model strategy for all products. 
  • Drives execution through direct staff and dotted line business partners of key clinical initiatives supporting the clinical model strategy.
  • Development of appropriate business metrics to optimize decisions, clinical outcomes and productivity
  • Continual coordination of multiple projects and priorities while keeping internal and external stakeholders informed
  • Ensuring quality assurance practices are implemented and upheld; monitor and report on quality in addition to maintaining industry standards
  • Partnering with key operations and support teams and leaders to define program requirements, expected benefits, and associated service level agreements are met
  • Develop and execute proactive analytics that drive an effective UM program
  • Responsible for achieving an affordability agenda
  • Monitor and maintain appropriate clinical and non-clinical claim system edits
  • Identify and study general and specific utilization trends, and adjust UR program to target services and providers for prospective global claim review
  • Develop and maintain a UM program strategy to profile provider utilization, including focused provider review, including UM vendors and consultants
  • Research targeted provider utilization based on utilization profile, counsel on their patterns, issue provider report cards, recover funds as appropriate, and refer suspected fraud and abuse for action
  • Maintenance of Quality Management Program, Quality Improvement Program
  • Oversees and ensures the development and implementation of Clinical Quality Programs initiatives to meet or exceed HEDIS & EPSDT quality standards.
  • Determination of grievance and appeals and dental process oversight
  • Coordinate and monitor provider and site audits for managed care and Medicaid networks as indicated by local regulatory requirements
  • Engaging in RFP creation and evaluation and development, negotiation, and monitoring of SOWs associated with external solution vendors
  • Development and  maintenance of policies and procedures 
  • Monitoring and maintenance of clinical review guidelines for global and focused review
  • Responsibility for regulatory compliance on all dental products and functions
  • Liaison with Legal and Product Development on managed care contract, compliance, and regulatory filings
  • Create and implement a progressive approach to the UM function, including appropriate staffing and vendor selection
  • Recruiting, talent development, and ongoing engagement of professional staff

Required Qualifications: 
  • Bachelor’s Degree in Healthcare or related equivalent
  • 7-10 years managing a dental program or equivalent and clinical and non-clinical staff related to the quality and care management activities
  • Management and implementation of UM on a national level
  • Experience with Claim Reviews including Fraud and Abuse
  • Experience in Quality Management
  • Experience with Client and regulatory audits
  • Excellent communication, collaboration, team building and relationship management skills
  • Successful in obtaining results in a large corporate, matrixed environment
  • Capable of gaining support for initiatives through influence and use of business rationale
  • Proven ability to make and implement tough decisions
Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 14 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can 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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