Director Business Process - Remote

UnitedHealth Group; San Antonio (TX); Remote; USD 124,000 - 240,000; Full time

Job summary

An innovative organization is seeking a seasoned leader to manage provider incentive programs and improve health outcomes. This role involves developing incentive strategies based on HEDIS and STARs metrics, ensuring quality standards are met, and fostering relationships with healthcare professionals. The position offers the flexibility of remote work, a competitive salary, and a comprehensive benefits package. Join a team that values diversity, inclusion, and career development while making a significant impact on community health equity.

Benefits

Comprehensive benefits package

Equity stock purchase

401(k) contributions

Incentive and recognition programs

Qualifications

• 15+ years of management experience in managed care, including 5+ years at Director level.
• Strong understanding of federal and state laws related to managed care.

Responsibilities

• Manage provider incentive programs and ensure quality standards are met.
• Develop and translate HEDIS and STARs metrics into effective incentive programs.

Skills

Management-level experience in managed care

Knowledge of HEDIS and STARs metrics

Excellent communication skills

Relationship management

Education

Bachelor's degree

Master's degree (preferred)

Job description

Job Description

Optum is a global organization that delivers care, aided by technology, to help millions live healthier lives. The work with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data, and resources they need. We foster a culture guided by diversity and inclusion, talented peers, comprehensive benefits, and career development opportunities. Join us to make an impact on the communities we serve as we advance health equity globally. Caring. Connecting. Growing together.

You’ll enjoy the flexibility to work remotely from anywhere within the U.S. and tackle some tough challenges.

We reward and recognize your performance in an environment that challenges you, provides clear success criteria, and offers development opportunities for other roles you may be interested in.

Responsibilities

1. Manage provider incentive programs, working with STARs and HEDIS performance metrics to ensure provider networks engage in competence and practice screenings, as well as care management to meet quality standards.
2. Develop incentive programs that offer bonus dollars, similar to CMS STAR ratings, but at the provider level.
3. Translate HEDIS and STARs metrics into effective incentive programs.
4. Drive all aspects of managing incentives, including creating reporting tools, presenting updates, tracking effectiveness, and monitoring financials.
5. Ensure investments in these programs yield positive returns.

Required Qualifications

• 15+ years of management-level experience in managed care, including five or more years at the Director level or above.
• Knowledge of business environment and requirements, such as strategy changes and emerging needs.
• Understanding of federal and state laws and NCQA regulations related to managed care and Medical Management.
• Knowledge of fiscal and human resource management techniques.
• Proven ability to establish and maintain effective relationships with employees, managers, healthcare professionals, physicians, senior administration, and the public.
• Excellent verbal, written communication, presentation, and facilitation skills.
• Willingness to travel as required by business needs.

*All remote employees must adhere to UnitedHealth Group’s Telecommuter Policy.

The salary range is $124,500 to $239,400 annually, based on full-time employment, considering factors like local labor markets, education, experience, and certifications. Benefits include a comprehensive package, incentive and recognition programs, equity stock purchase, and 401(k) contributions, subject to eligibility. Benefits may vary.

Application Details

This posting will remain open for at least 2 business days or until a sufficient candidate pool is gathered. Early removal may occur due to application volume.

Our Mission & Commitment

UnitedHealth Group aims to help people live healthier lives and improve the health system for everyone. We are committed to addressing health disparities and promoting equitable care, especially for marginalized groups and those with lower incomes. We also prioritize environmental sustainability.

We are an Equal Employment Opportunity employer. Qualified applicants will be considered regardless of race, gender, sexuality, age, location, income, or other protected characteristics. We are a drug-free workplace requiring candidates to pass a drug test before employment.