Health Services Director, C&S WA - Remote in WA

UnitedHealthcare; New York (NY); Remote; USD 124,000 - 240,000; Full time

Job summary

An established industry player is seeking a Statewide Health Services Director to lead case management and clinical programs across the Washington market. This role involves collaborating with national and local leadership to enhance healthcare delivery for diverse populations. The ideal candidate will possess strong leadership skills, a robust background in healthcare operations, and a commitment to improving health outcomes. Join a mission-driven organization dedicated to fostering healthier communities and making a meaningful impact in the lives of millions. This position offers flexibility and the opportunity to work remotely while ensuring compliance and quality in care management.

Benefits

Comprehensive benefits

Incentive programs

Equity stock purchase

401k contributions

Qualifications

• 5+ years of professional experience in healthcare administration or consulting.
• Active RN license in Washington required.

Responsibilities

• Manage onboarding, training, and support for care management programs.
• Ensure compliance with state and federal regulations in clinical care management.

Skills

Leadership

Healthcare Administration

Clinical Services

Managed Care

Conflict Resolution

Education

Active RN License in Washington

5+ years of professional experience

Job description

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.

The Community & State (C&S) Statewide Health Services Director provides oversight of all case management, clinical program adherence, and outcomes across the Washington market. The populations include but are not limited to Apple Health Medicaid, Dual Special Needs Plan (DSNP), Justice Involved, Private Duty Nursing (PDN), and maternity members. This leader will work in close partnership with both national and local leadership including clinical, pharmacy, operations, and finance.

If you reside in Washington or within a commutable distance, you'll enjoy flexibility to work remotely* as you tackle some challenging issues.

Primary Responsibilities:

1. Management onboarding, training, and support
2. RFP development and implementation for the Washington market
3. Provide leadership oversight by ongoing & annual evaluation of care management programs to ensure efficacy. Partner with local and national health plan leaders to adapt clinical interventions to better meet the needs of the populations served
4. Partner with compliance leads and adherence teams on all compliance-related topics, ensuring clinical care management and documentation meet all requirements, policies, and procedures
5. Support clinical internal and external audits and accreditation activities
6. In partnership with the Quality team, develop a work plan for continuous quality improvement of clinical care management operations and performance
7. Assist the Director in establishing MBOs for the Care Management team aligned with QD and CMO MBOs
8. Implement and support remediation plans to ensure DSNP MOC and NCQA Care Management adherence
9. Implement C&S clinical operations models and monitor their performance
10. Collaborate with the national affordability team on clinical affordability projects
11. Serve as the lead between the health plan and national support functions, managing program changes, implementation, training, etc., balancing local needs with national programs
12. Understand and translate state and federal legal and contractual care management regulations into operational metrics and protocols
13. Ensure clinical remediation plans are developed and successfully implemented for corrective actions
14. Drive collaboration with shared service partners using audit and reporting metrics to meet contractual and regulatory requirements

You'll be rewarded and recognized for your performance in an environment that challenges you, provides clear success criteria, and offers development opportunities.

Required Qualifications:

1. Active, unrestricted RN license in Washington
2. 5+ years of professional experience
3. 3+ years in healthcare including Managed Care, healthcare administration, or consulting
4. 3+ years in healthcare operations, clinical services, network, products, and benefits
5. 3+ years in leadership and management roles
6. Experience working with state regulators
7. Driver's license and reliable transportation with up to 25% local travel
8. Reside in Washington or willing to relocate

Preferred Qualifications:

1. Supervisory clinical experience
2. Experience with financial affordability
3. Customer-focused with strong conflict resolution skills and organizational sensitivity
4. Ability to translate strategic objectives into action plans and lead teams effectively
5. Flexibility to adapt and change as needed

*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, with additional benefits such as comprehensive benefits, incentive programs, equity stock purchase, and 401k contributions. Benefits are subject to eligibility.

Our mission is to help people live healthier lives and improve the health system for everyone. We are committed to addressing health disparities and promoting equity in care, reflecting our enterprise priority and mission.

UnitedHealth Group is an Equal Employment Opportunity employer and a drug-free workplace. Candidates must pass a drug test prior to employment.