The Director of Clinical Optimization (DCO) is a highly visible role which is responsible for ensuring that all customer commitments are met, including clinical-based and operations targets in a fast paced, multi-stakeholder environment. This Director has significant customer interface and acts as the liaison between account management and operations.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:- Single point of contact for UnitedHealth Care Strategic Client Executives and Optum Strategic Account Executives for a portfolio of strategic National and Key Accounts
- Role serves as the program director for clients including managing population of over 360K members and 50+ clients with specific focus on partnership with the consultant (Mercer) including intense support, including HCC reviews and onsite strategy meetings
- Accountable for the end-to-end operational performance against Customer deliverables within Population Health Service delivery
- Manages Customer commitments and expectations jointly with Account Management Team
- Ensures scalability and sustainability of Customer specific operational processes delivering against Customer commitments
- Drives Customer performance against quality metrics; communicates customer status and remediation action plans
- Proactively identifies and mitigates potential service gaps and customer specific quality opportunities ensuring a timely resolution.
- Monitors the performance of Optum products to ensure program metrics are meeting internal operating goals
- Track and manage to client-specific clinical performance guarantees (CPG) and claims trend guarantees (CTG)
- Contribute to client-facing presentations of program performance results in health plan reviews and Customer partnership meetings
- Responsible for researching and resolving clinically related member escalations
- Participate in Customer specific implementation meetings (internal & external), including client transitions as necessary; conducts post-implementation system audits
- Partners with clinical team & leadership to identify, implement and monitor outcome- based strategies tailored to Customer-specific culture and membership
- Collaborates with internal and external programs to ensure strong integration with clinical programs and efficient vendor referral processes
- Proposes, implements & monitors customer-specific service delivery pilots to address efficiency opportunities and process gaps
- Develops and leads execution of continuous improvement initiatives to ensure exceptional member experience and Customer satisfaction
- Engage in Customer audit preparation meetings, including initial scope discovery meetings; partners with the Audit Team, Operations and Product to prepare pertinent materials and slides
- Manage post Customer audit action plans to completion through accountable owners
- Contributes to & participates in High-Cost Claimants reviews if service purchased by customer and Exception is approved with defined parameters
- Partner with internal resources across operations, business intelligence and product to enhance cross-program coordination
- Responsible for presenting Customer Performance reporting to internal audiences
- Works with Product owners and Finance to ensure profitability of the model
- Participate in finalist meetings and contribute to renewal RFPs demonstrating expertise and knowledge of their membership
- Contributes to and participates in 1) AMT & Partnership meetings, as defined by purchased product, 2) QBRs to provide Customer-specific commentary on remediation plans, 3) external Customer & vendor meetings
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:- 2+ years of managed care clinical operations or account management experience
- 2+ years of customer/client presentation experience
- Experience managing client and stakeholder relationships: internal (staff, matrixed resources) and external (client, carrier, consultants & vendor)
- Experience in negotiations and gaining consensus across a multidisciplinary team (internal & external partners) to include Clinical Consultants, product, and account management
- Program management experience
- Experience analyzing and interpreting customer/client data and making recommendations to operations / clients based for improvement based on data
Preferred Qualifications:- Registered Nurse with active RN license
- 5+ years of Call Center operations experience
- 3+ years of experience as a Registered Nurse in a clinical setting
Competencies:- Operational End to End thinker: broad program and delivery modality knowledge
- Strategic operations leader: able to make decisions and drive execution
*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 $112,700 - $193,200 annually based on full-time employment. We comply with all minimum wage laws as applicable.
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.
