At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

The Director, Complex Pediatric Clinical Strategy will have accountability for the development, execution, and evaluation of the clinical strategy for the complex pediatric population for UnitedHealthcare Community & State. This individual will establish the framework to support a comprehensive approach for the child and adolescent population with complex need. This framework will advance a suite of solutions that empower members/families, improve the experience for members, drive improved outcomes, reduce costs, promote a sustainable, coordinated provider and community ecosystem, and accelerate growth. This framework will integrate evidence-informed and best-practice strategic solutions, at the care management, provider, individual/family, and systems levels. These strategies will help position Community & State as an innovative leader in this space, allowing for a robust articulation of solutions in competitive rebid and greenfield RFP situations.

In this role, you will serve as a key team member, reporting to the VP Complex Populations Clinical Strategy and Program Development. Your responsibilities will include the development, execution, and operations and financial measurement of the comprehensive clinical strategy and model for complex pediatric population. In addition, you will be a key liaison to leadership through executive reporting, sharing strategy, and partnering with internal/external programs.

This role works with team leaders and matrix partners including Medicaid Clinical Strategy, Medicaid Workforce Management/Training, Clinical Implementations/Adherence, Healthcare Economics, Network, Optum Behavioral Health Services, local health plan leaders, and other functional areas.

This role is responsible for promoting and driving a differentiated set of solutions across 20+ Medicaid markets. To keep up with changing trends and member preferences, the Director will advance the adoption of digital solutions to improve member outreach and engagement, accelerating evidence-informed interventions, and designing partnerships with provider and community-based organizations to drive improved health outcomes.

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

Primary Responsibilities:

• Provides leadership to develop and design a comprehensive clinical model and strategy
• Provides leadership to and is accountable for the performance and direction of assigned programs, managing end-to-end execution and value delivery through partnership management, as well as driving and enhancing existing capabilities, all from inception through launch and measurement stages
• Owns the relationship with vendor/internal programs, serving as primary point of contact, and maintains positive, productive, open working relationships at all levels
• Assess evidence base, competitive landscape, population framework, financial drivers, partner strategy and market trends to inform development and improvements to the model
• Brings forward recommendations and drives to resolution to gain cross-functional alignment and decision-making
• Evaluates financial forecasting and affordability opportunity in partnership with HCE and matrix partners, socializes with leadership, develops and executes action plans based Partner with network team to develop and implement alternative payment models to create greater access to care and drive improved health outcomes
• Establish evaluation and ongoing monitoring strategies, and analyze relevant data sources to determine program effectiveness, identify improvement areas to enhance efficiencies, and implement process improvement activities
• Supports the program maturity lifecycle by ensuring smooth and timely program expansion, draw down, or transitions to other programs, keeping data driven approach to monitoring the implementation or draw down plan
• Proactively develops various communication elements to socialize and align stakeholders regarding projects and statuses to facilitate decision making and understanding with the business and other partners, including develops executive level program summaries and communications
• Participates and co-leads minimally quarterly performance review Joint Operating Committee meetings (JOCs) with program leaders, may be monthly with immature programs, providing oversight that JOCs are productive, driving agendas, ensuring follow-up items tracked and addressed to completion
• Develop internal relationships and lead cross-functional engagement (e.g. network, behavioral health, clinical, etc) to support development of strategies
• Provide thought leadership and serve as SME for business and functional partners

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:

• 5+ years of experience working with pediatric populations in a healthcare setting
• 3+ years of experience in Medicaid Managed Care
• 3+ years of experience in HCBS/LTSS and/or NICU/PICU setting
• 3+ years working in a matrix organization
• 2+ years of experience working in a C&S health plan
• Experience coordinating priorities, executing development, and driving progress in a large, diverse organization
• Experience with business case development
• Intermediate or higher level of proficiency in Microsoft Excel, Word, PowerPoint
• Proven solid communication skills, including written, spoken, and presentation communications
• Proven highly collaborative individual with the ability to build solid professional relationships at all levels and across business lines
• Proven excellent planning and problem-solving skills to quickly identify and resolve issues
• Proven ability to operate well with ambiguity, self-starter, can operate in the unknown
• Proven ability to analyze data for evaluation of program effectiveness
• Proven ability to create ad hoc reports, accessing data from various sources, and synthesize and present insights
• Proven ability to motivate business unit leaders and strategic partners and work within teams effectively using influencing skills to drive to efficient and effective decision-making and building a collaborative culture

Preferred Qualification:

• RN, LSW or LPN/LVN

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

California, Colorado, Connecticut, Hawaii, Maryland, Nevada, New Jersey, New York, Rhode Island, Washington, Washington, D.C. Residents Only: The salary range for this role is $122,100 to $234,700 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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.