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As a manager you will be charged with helping to implement and drive 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 and follow up, performance scorecard development and publishing on behalf of the markets, and generalized support for programs as capacity is needed.
As a manager of Payment Integrity and Affordability for M&R, you will report to the Director of Payment Integrity M&R Affordability and Value. You will be a key contributor to the Payment Integrity 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 and ensuring the potential impact of affordability initiatives are understood and evaluated from a Stars risk perspective. This role requires cross functional coordination with healthcare economics, actuarial, finance, UHN, Stars team and the UHC and Optum Payment Integrity partners. This role requires the ability to build trusting relationships and to drive business goals with sister departments in UHC and Optum. Driving business strategies and processes throughout and across our matrix organization is a critical function of this position.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.
Primary Responsibilities
- Business Planning and Regular Reporting
- Facilitates execution of M&R's Payment Integrity affordability strategy to targets in conjunction with key payment integrity partners, providing insight and recommendations and ensuring alignment
- Tracks progress against M&R's Payment Integrity value plans, identifies any deviations to support remediation plans; provides reports and analysis as required
- Supports the Preparation of Affordability outlook executive summaries for Payment Integrity for Govt Programs Affordability EVP for use in monthly forums with UHC C-Suite Leadership (CEOs, CFOs, CMOs)
- Communicates effectively to leadership - written and verbal, internal and external
- Supports Strategic portfolio management
- Supports the development and ongoing maintenance of the Medical & Clinical Operations Business Strategy document
- Demonstrates effectiveness and efficiency in project planning, task-management, risk mitigation, and program execution
- 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 UHC Payment Integrity, 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
- Manage relationships with key ideation partners, including UHC Ns Optum Payment Integrity
- Design and Sourcing:
- Research existing solutions to identify opportunities (published study, competitor offerings, vendor solutions, learnings from sister lines of business, etc.)
- Supports the development of proposals to optimize 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 leadership and key stakeholders, identifies best partners for implementation and execution of affordability and value solutions.
- Implementation:
- Works with leadership and selected partners to build 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-appraise 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 regularly monitored for all affordability programs within the Payment Integrity Network domain
- 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
- Develop relationships with key partners, including Payment Integrity, Network, Healthcare Economics, Clinical, Claims and Finance
- Develop relationships with key domain stakeholders, including regional and market CEOs, CMOs, Stars teams, Compliance, Legal and more
- Regularly connected with Payment Integrity affordability director 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
- 3+ years of healthcare or related industry experience
- 3+ 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
- Database management and data analytics capabilities, including experience working with large and complex datasets.
- Proficiency in leveraging technology and data management tools to improve operational performance and business outcomes.
- Expert-level proficiency in Microsoft Excel, PowerPoint, and the Microsoft 365 suite of products.
- 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
- Demonstrated 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
- Demonstrated solid ability to create executive presentations, dashboards, and reports that communicate insights and support decision-making
- Proven solid data analytical skills; ability to quickly interpret information and draw conclusions
Preferred Qualifications
- Payment Integrity or Affordability experience
- 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 ability to build relationships cross-functionally and lead toward common goals
- Proven excellent communication skills; ability to independently produce written communication for executive leaders
*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 $91,700 - $163,700 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.
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.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.