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SVP Enterprise Care & Value - 2229193

UnitedHealth Group

UnitedHealth Group

San Antonio, TX, USA · New Braunfels, TX, USA
Posted on Sunday, June 9, 2024

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

The Senior Vice President of Enterprise Central Care Management Operations is a member of the executive management team, reporting directly to the Executive Vice President, WellMed Medical Management, Inc. The position provides strategic direction, leadership and oversight for Enterprise Care Management programs including Utilization Management, Disease Management, and Complex Case Management. This position also is responsible for planning, organizing, and directing the administration of all Care Management programs across multiple geographies.

Provides leadership to and is accountable for the performance and direction through multiple layers of management and senior level professional staff. Responsible for coordinating with appropriate personnel to meet operational program needs, ensures compliance with state/federal health plan requirements, Medicare guidelines, NCQA and health plan requirements. Provides long-term planning and oversight to ensure activities are appropriately integrated into strategic direction and operations, as well as the mission and values of the company.

This position also serves on multiple Optum Clinical Committees and leadership teams designed to provide strategic direction for all local care delivery groups within Optum.

Primary Responsibilities: The Enterprise SVP of Central Care Management Operations works closely with WellMed Executive Leadership and the Regional Care Management leadership as well as the Regional Dyads to achieve the goals and objectives of the Enterprise Care Management Program.

Care Management Programs: Utilization Management, Population Health, Complex Case Management, Pilot Programs

  • Designs and directs UM, DM, CM program descriptions, work plans, program evaluations and overall Model of Care
  • Directs the development, planning and execution of continual process improvement efforts, policies, procedures, and regulatory compliance functions related to care management activities
  • Assists with the development of the UM Work Plan, Evaluation and the monitoring of the Work Plan activities as they related to clinical performance improvement
  • Provides vision and leadership to advance the care management program under WellMed to the next level of service
  • Collaborates with physician leadership to execute the implementation of the care management programs as defined by Enterprise as well as Optum
  • Promotes understanding, communication and coordination of all care management programs components with regions and their leadership
  • Provides oversight for all activities related to delegated and regulatory requirements including annual health plan delegation audits
  • Drives adoption of best practices and trends for UM, CM, DM activities
  • Participates in health plan CMS audits
  • Monitors/analyzes metrics/data/trends, and ensures areas needing attention are communicated to applicable stakeholders
  • Drives UM performance to meet targets for admissions, readmission and total health care costs for the organization
  • Develops operating budget as necessary and participates on various teams, committees, and meetings at WellMed and Optum
  • Designs and directs configuration for UM, CM, DM core application system
  • Drives and assists in the design of strategic plans and management of enterprise-wide, large-scale clinical initiatives, pilots, and projects promoting quality care for seniors
  • Directs and oversees innovation initiatives, data analysis activities, and evaluation strategies for clinical programs including, but not limited to, pilot projects, grant-funded research projects, and publication endeavors related to the population we serve in multiple markets
  • Develops strategic partnerships, joint ventures and learning opportunities with medical academies/associations, academic institutions, and organizations with local, national and global impacts to population health

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

  • Bachelor’s degree in Nursing (8 additional years of comparable work experience beyond the required years of experience may be substituted in lieu of a Bachelor’s degree)
  • Registered Nurse with current license in Texas, or other participating Compact states preferred
  • 8+ years of progressive responsibility with at least 3 of those years at a director-level or higher position
  • Knowledge of federal and state laws and NCQA regulations relating to managed care, delegation, disease management, utilization management, discharge planning and complex care case management
  • Broad business background with strong skills and experience within a functional area; may have expertise within a specialty or sub-function
  • Knowledge of basic principles and practices of clinical nursing
  • Knowledge of referral processes, claims, case management, utilization management and contracting and physician practices
  • Knowledge of fiscal management and human resource management techniques
  • Effective written and verbal communication skills
  • Presentation skills with ability to represent company to organizations / individuals in a professional manner
  • Proficient with computer software programs, to include: word processing, spreadsheets graphics and databases
  • 50% travel (local and out of area) expected

Preferred Qualifications:

  • Master’s degree
  • 8+ years of experience in managed care and/or disease management with a minimum of 5 years at a management level

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

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.