Program Director

UnitedHealth   •  

South Portland, ME

Industry: Healthcare


11 - 15 years

Posted 63 days ago

This job is no longer available.

Position Description

The Medicare & Retirement Program Director is responsible for establishing market-level goals in key areas aligned to the regional P&L goals, and tracking market progress toward those goals. This position will analyze data and identify key trends and opportunities, narrowing down the focus to the critical few that need to be prioritized and addressed. This position will also develop and lead targeted programs and initiatives across markets. Areas of focus will include provider engagement and aggregation, establishing structured data connectivity, HEDIS data collection, risk adjustment, and medical trend. This position is the right-hand to the Healthplan CEO. If you are located within Central and Eastern Time zones you will have the flexibility to telecommute* as you take on some tough challenges. Primary Responsibilities:

  • Partner with Optum Quality Field Operations to identify and prioritize market provider targets, establishing quality targets for each group, tracking progress toward those targets, identifying and eliminating barriers, and driving key initiatives
  • Network with Clinical Transformation Consultants and ACOs and key provider groups to build relationships and partner on key initiatives to drive success, including member growth
  • Drive HEDIS performance within the local market, monitoring and reporting on progress, while identify opportunities for improvement and supporting the team’s HEDIS reporting needs
  • Partner with Optum to drive the risk adjustment programs and processes, including Housecalls
  • Lead affordability initiatives by partnering with Healthcare Economics to identify opportunities and working cross-functionally with key teams to implement strategies to resolve those opportunities.
  • Support clinical improvement strategies identified by clinical team to improve key clinical metrics across the market
  • Market-level vendor management for key external partners like HealPros and MedXM
  • Understand the provider contracting landscape and partner with network development to address deficiencies
  • Partner with Provider Advocates to address concerns raised by key providers
  • Partner with Sales to address key network or operational concerns and support sales as needed to ensure strength member growth in the market
  • Understand available reporting and generate ad hoc reports to support market efforts, as needed
  • Provide market-level support and review for key processes like provider directories, ID cards, Summary of Benefits, etc.
  • Serve on various regional and national strategy teams to address key needs of the business

Required Qualifications:

  • Bachelor’s Degree
  • 10+ years of professional experience in finance, strategy, operations, business intelligence, data analytics orproject management
  • Demonstrated knowledge of Medicare Advantage
  • Experience working with healthcare providers
  • Extensive Microsoft Office experience, especially Excel

Preferred Qualifications:

  • Strong analytical skills including experience working with various business intelligence tools (e.g., COGNOS, SAS, etc.)
  • Strong executive presentation and communication skills
  • Ability to network and form strong relationships with key partners
  • Strong organization and time management skills

At UnitedHealthcare, we're addressing the social drivers of health ? and helping to change the broader circumstances of members' lives ? providing greater stability, access, and wellbeing that can allow members to rise out of poverty. What's more important than that? So join us and lead initiatives toinfluence state or national policy and do your life's best work.SM

Careers at UnitedHealthcare Medicare & Retirement.
The Boomer generation is the fastest growing market segment in health care. And we are the largest business in the nation dedicated to serving their unique health and well-being needs. Up for the challenge of a lifetime? Join a team of the best and the brightest to find bold new ways to proactively improve the health and quality of life of these 9 million customers. You'll find a wealth of dynamic opportunities to grow and develop as we work together to heal and strengthen our health care system. Ready? It's time to do your life's best work.SM