The UnitedHealthcare Clinical Services Business Standardization and Advancement (BSA) team is charged with supporting the UHC UCS organization across multiple domains. BSA leadership is responsible for ensuring that all Utilization Management activities as well as other organization initiatives align to regulatory adherence requirements and are supported by accurate process documentation while ensuring delegates and other service providers are functionally aligned to UHC imperatives and requirements.. Position Responsibilities:. Lead large diverse team with varying responsibilities and accountabilities including but not limited to:. UCS Clinical Business implementation (client implementations, RFP, document support). Regulatory adherence, accreditation & delegated credentialing. Learning Performance and Solutions (training). Clinical Business Performance Oversight (CBPO) delegation oversight and remediation. Clinical Program performance Management - client facing. Provide Clinical Subject Matter Expertise and strategic direction, leadership and management for teams , processes and projects. Support best practices while simultaneously striving for standardization and ensuring optimal operational performance aligned to all regulatory requirements, client expectations and economic value.. Supporting the development of and delivery of tactical plans across multiple domains, internally and externally including performance, affordability, regulatory adherence , client specific requests & contractual requirements. In-depth knowledge of Medicaid, Medicare and commercial plan requirements, challenges and innovation opportunities. Lead discussions; provide guidance on tactical planning, project and programs. Provide executive leadership and ownership of the UCS business continuity plan ensuring that operational requirements and timeframes align to regulatory requirement during internal or external events. Work in close collaboration with UCS clinical operational leadership and other key partners to prioritize, plan, structure and implement Clinical Affordability initiatives. 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 UCS Organizations clinical and operational leaders and others across the UHG organization. Ensure operational compliance with all requirements (e.g., CMS, NCQA, URAC, Health Plan, state).. Coordinate training requests, prioritize resource allocation and solutions. Oversee delegation oversight activities designed to ensure compliance and improve clinical performance outcomes of our regional and national delegates. Knowledge of change management and remediation activation strategies. Vendor management strategies (MCG, IQ VRO). Critical Success Factors:. Ability to effectively lead, manage and deliver in a fast paced, ever changing environment. Ability to foster communications, robust collaboration and strong partnerships amongst key partners (e.g., HCE, IT, UHN, Operations, 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. Required Qualifications:. Masters degree in healthcare administration, nursing or business. 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. Knowledge of Health plan URAC & NCQA accreditation requirements. Deep knowledge of medical management with solid experience working in the following: Utilization Management (CM, DM, Pre-Service, Concurrent Review). Proficiency in Microsoft Power Point, Excel, Word, Visio, Outlook. Strong written and verbal communication skills. Proven experience managing organizational growth and change. Preferred Qualifications:. Knowledge of Federal (e.g., CMS) and state laws and regulations relating to managed care (e.g., medical management, utilization management). Knowledge of fiscal and human capital management techniques. Registered Nurse. Specialty certification: CPHQ, CCM. Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 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). Diversity creates a healthier atmosphere: Employer 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.. Employer is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Associated topics: administrative coordinator, administrative officer, administrative staff, assist, associate, front desk, front office, food, operations director, records management