Director of Medicare and Retirement Affordability - Remote

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.

As a strategic leader you will be charged with developing and helping to oversee the affordability strategy for the nation's largest Medicare Advantage plan.

The Medicare and Retirement (M&R) Affordability and Value team is responsible for executing our line of business affordability agenda in partnership with key collaboration partners across clinical, payment integrity and network. Our team supports the full lifecycle of value including analytics and ideation, design and sourcing, implementation, ongoing governance, and continuous improvement. Our team supports the foundational cadence of running the business including the business planning cycle, monthly and quarterly business review preparation and follow up, performance scorecard development and publishing on behalf of markets, and generalized support for programs as capacity is needed.

As the Director of Payment Integrity and Network Affordability and Value for M&R, you will report to the VP of M&R Affordability and Value. You will be responsible for the Payment Integrity and Network affordability strategy and execution, identifying and implementing new affordability strategies and governing existing partnerships. This includes driving to annual affordability targets and governing greater than $100M in program spend annually. You will be responsible for improving the consumer and provider experience. This role requires cross functional leadership with healthcare economics, actuarial, finance, UHN, United and Optum Payment Integrity partners. This role requires the ability to build trusting relationships with health plan leadership and the ability to drive business goals with sister departments in UHC and Optum. You must understand how to drive complex business strategies and processes throughout and across our matrix organization.

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

Primary Responsibilities:

Business Planning and Regular Reporting

• Facilitates development of M&R's Payment Integrity and Network affordability strategy to targets in conjunction with key payment integrity and network partners, providing insight and recommendations and ensuring alignment
• Tracks progress against M&R's Payment Integrity and Network affordability and value plans, identifies any deviations and suggests plans to remediate; provides reports and analysis as required
• Prepares Affordability outlook executive summaries for Payment Integrity and Network for Govt Programs Affordability EVP for use in monthly forums with UHC C-Suite Leadership (CEOs, CFOs, CMOs)
• Prepares Affordability outlook executive summaries of non-Delegated functions (Payment Integrity, Network) for Optum Home and Community Leadership
• Participates in strategic planning for P&L owners and assists in developing specific plans as needed, including long range planning models
• Communicates effectively to leadership - written and verbal, internal and external
• Strategic portfolio management
• Efficient in project planning, task-management, risk mitigation, and program execution
• Cultivation of solid business relationships

Analytics and Ideation:

• Maintains a cadence of regularly reviewing internal and external data and trends to identify areas of risk and/or opportunity, in partnership with HCE and others
• Partners with Clinical Affordability Value Business Analyst, HCE and M&R Finance to analyze year over year gross and incremental affordability performance, Program ROI summaries and data visualizations for use in C-Suite level updates
• Defines and manages relationships with key ideation partners, including UHC Payment Integrity
• Periodically performs/commissions benchmarking studies to identify opportunities

Design and Sourcing:

• Researches existing solutions to opportunities identified (published study, competitor offerings, vendor solutions, learnings from sister lines of business, etc.)
• Develops proposals to support optimized achievement of the triple aim for UHC M&R's consumers and providers. Proposals consider administrative costs, capital investments, medical cost impact, user experience, quality, compliance, market competitiveness, and more, as well as the balance of risk/reward and the future maintenance of the solution
• In partnership with key stakeholders, identifies best partners for implementation and execution of affordability and value solutions, and negotiates excellent terms of the business relationship, as well as all critical business requirements, service level agreements, performance guarantees and future state governance
• Secures delegation of authority sign offs for new/adjusted programs and incorporates in forecasting

Implementation:

• Works with selected partners to fully charter new/adjusted program implementation plans including detailed objectives (KPIs), key milestone dates, scope, roles and responsibilities, etc.
• Manages new/adjusted program implementation actively, quickly working through obstacles, escalating barriers, enabling decisions (Owned by Pillars)
• Keeps stakeholders well-apprised of positive and negative changes in outlook and provides regular status updates

Governance and Continuous Improvement:

• Ensures performance expectations (KPIs, service level agreements, performance guarantees, etc.) are well defined and regularly monitored for all affordability programs within the
• Payment Integrity and Network domains
• Quickly addresses and/or escalates performance deterioration and emerging risks to protect the company and its members and providers. Ensures appropriate mitigation is put in place for risks that can be avoided, and that damages are collected for risks that manifest
• Leverages insights from stakeholders, benchmarking and other sources to continually improve program ROI and other value, including but not limited to rate optimization for efficiencies

Organizational Alignment

• Maintains and drives relationships with key partners, including Payment Integrity, Network, Healthcare Economics, Clinical, Claims and Finance
• Maintains and drives relationships with key domain stakeholders, including regional and market CEOs, CMOs, Stars teams, Compliance, Legal and more
• Regularly connects with the M&R Affordability leadership team to ensure program learnings, performance and dependencies are well socialized and considered

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:

• 10+ years of healthcare or related industry experience
• 5+ years of Payment Integrity or Network experience
• 5+ years of strategic management of complex products/processes/scope of accountability
• 5+ years of leadership experience (direct or indirect reporting relationships)
• 5 + years of business operations and execution experience with the ability to quickly diagnose and solve complex problems
• Experience within large, matrix organizations with demonstrated business results
• Operational experience to ground recommendations in clinical and business service workflows
• Demonstrated leadership and hands-on experience, solid leader and motivator with the ability to develop talent within the organization
• Demonstrated planning, project management and communication skills. Accurately scopes out projects, sets objectives and goals, develops schedules and resource assignments, measures performance against goals, and evaluates results
• Proven ability to deal with ambiguity - can cope with change, can shift gears comfortably, comfortably handles risk and uncertainty in a manner consistent with UnitedHealth Group's core values
• Proven solid analytical skills; ability to quickly interpret information and draw conclusions

Preferred Qualifications:

• UnitedHealth Group experience
• Finance or Health Care Economics experience
• Medicare Advantage experience
• Proven ability to work independently and effectively in a results-oriented, fast-paced environment
• Proven ability to synthesize complex information to drive decision-making
• Proven excellent communication skills; ability to independently produce written communication for executive leaders
• Proven ability to build relationships cross-functionally and lead toward common goals

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

The salary range for this role is $124,500 to $239,400 annually based on full-time employment. 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.