The Director, Integrated Products is responsible for the day-to-day operational functions of our Dual Special Needs Plan (DSNP), Integrated Benefits for Dually Eligible Enrollees (IB Dual) and Medicaid Advantage Plus (MAP) Plans including members who are receiving Long Term Services and Support (LTSS). The Director will work collaboratively with the Integrated Products Executive Director to ensure that the Health Plan is compliant with regulations pertaining to New York Integrated Products (both CMS and NYS Department of Health) and that all business functions run efficiently, regularly engaging automation and A/I opportunities. The Director will engage the team and other subject matter experts to ensure workflows are in place, effective, and can be reported on via dashboards or other means. This position is key to bridging strategy and execution and as such, should be engaged in understanding strategic direction and executing on that direction with operational efficiency and return on investment at top of mind. The Director should be a solid people leader able to effectively guide a dynamic team, drawing on meaningful training and development, communication and sharing of best practice ensuring alignment to organization goals. This position will also be responsible to initiate and engage in interventions to drive member satisfaction and will triage and manage member and provider level complaints when escalated. Additionally, the role will engage with National and Health Plan teams to help drive quality initiatives. Efficient operations coupled with a focus on quality and member satisfaction will allow the Health Plan to grow, offering a top-notch integrated product and experience to members.
If you reside in NY, NJ, CT, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities:- Leading and managing all functional, technical, operational, and reporting activities for long term services supports (LTSS) across all lines of business for the New York Health Plan
- Ensures compliance with state and federal laws, Medicare regulations and health plan policies and procedures
- Collaborates with the National STARs lead to develop member campaigns that will directly impact performance in consumer satisfaction surveys
- Collaborates with the Medicaid Quality Director on projects impacting HEDIS measures/performance
- Create criteria and/or policy and procedures to achieve quality, and productivity goals
- Forecast revenue of LTSS and related products through project implementation such as Medicaid Advantage Plus (MAP) and Default Enrollment
- Collaborate with Clinical Operations team regarding enrollment and clinical activities of long-term care members across all lines of business
- Collaborate with Network Management team regarding network adequacy, quality, and efficiency of participating LTSS providers across all lines of business
- Monitor, manage, and improve the efficiency of support services such as IT, Claims, and Finance
- Liaison for plan with state contacts at the Department of Health (DOH) and New York Medicaid Choice (Maximus) related topics for all NY line of business at UHC
- Operationalize enrollment and eligibility process for MAP and new benefits in the Medicaid and DSNP markets that relate to LTSS
- Coordinate internal resources and third parties for flawless execution of projects
- Assist in defining project scope and objectives, involving all relevant stakeholders, and ensuring technical feasibility
- Keep abreast of industry trends and regulatory requirement by attending NYSDOH meeting and reviewing industry publications
- Operations lead for members enrolled in Dual-SNP Medicare Advantage Plans
- Manage Integrated Dual Membership Plan including State relationship
- Implementation of CMS & State requirements for Dual members
- Engage regularly with national partners to ensure understanding of changes in national programs design, new enhancements, etc.
- Manage PCS team to drive focus and initiatives
- OTC & Food benefit card oversight and vendor management
- Coordinate and collaborate with local plan personnel, functional areas, Medicare & Retirement, and National STARs team to reduce/prevent complaints to Medicare (CTM) and develop corresponding mitigation action plans Oversee call center functions
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 or equivalent experience
- 7+ years of healthcare experience including Managed Care, Medicaid and Medicare operations and/or compliance
- 7+ years working experience within healthcare operations, clinical services, network, products and benefits
Preferred Qualifications:- MBA, MHA, or MPH
- Experience in local markets leading affordability-, cost-, or finance-focused programs
- Experience with healthcare information systems
- Experience consulting experience between business and technology
- Medicaid knowledge
- Solid understanding of UHC operations, clinical services, network, products and benefits
- Demonstrated ability to translate strategic objectives into action plans and lead/motivate teams to execute plans effectively; flexibility to adapt and change direction as needed
- Proven customer-focused; proven ability to handle complex situations, resolve conflicts and issues effectively. Sensitive to how people and the organization function
- Proven solid analytical, financial, project management and problem solving skills; ability to quickly aggregate and analyze information and draw conclusions.
- Proven solid written and verbal communication skills capable of effectively presenting ideas and tactics at executive and non-executive levels, in internal and external settings
- Proven solid executive leadership presence, with ability to manage prioritization of programs and process across segment leadership, and effectively communicate strategy to attain goals
Competencies and Best Practice for High Performers:- Achievement Drive
- Critical Thinking
- Leveraging Innovation
- Leading Change and Transitions
- Managing Teams
- Enterprise Insight
- Results driven- Business Management/Business Judgment
- Ability to manage and drive execution with minimal oversight-Interpersonal Skills/Self-Management
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $134,600 - $230,800 annually based on full-time employment. We comply with all minimum wage laws as applicable.
