Clinical Affordability Director – Telecommute

  • UnitedHealth Group
  • Remote
  • Mar 25, 2022
Registered Nurse

Job Description

Compassion. It’s the starting point for health care providers like you and it’s what drives us every day as we put our exceptional skills together with a real feeling of caring for others. This is a place where your impact goes beyond providing care one patient at a time. Because here, every day, you’re also providing leadership and contributing in ways that can affect millions for years to come. Ready for a new path? Learn more, and start doing your life’s best work.SM

UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm)

Serve as Clinical Affordability Director for clients in the Premier Hub model.  These clients are the most complex, strategic and profitable clients for which the management of the trend is essential.   This clinical position works in collaboration with the Chief Operations and Lead Medical Director to develop and implement action plans that achieve client outcome expectation.  This will contribute to the retention of clients by ensuring programs provides exceptional clinical value and medical cost management. Consult with senior leadership and healthcare consultants to identify innovative strategies and tactics for operational excellence. Develop action plans to mitigate trend, monitor progress against plans, identify and prevent service quality issues.  Develop and implement innovative clinical solutions to client-specific requirements.  A clinical skill set is essential to identify and intervene appropriately to drive team and member engagement.  

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

Primary Responsibilities:

  • Contribute to growth and profitability of the model by ensuring the program provides exceptional clinical value and medical cost management for each individual client through identification and valuation of solutions. Tasks include but are not limited to:
    • Develop and lead presentation of Medical Cost Action Plans (MCAPs) for the designated list of customers to effectively manage client’s trend target
    • Partner with the Lead Medical Director, Strategic Client Executive, and Health Plan Consultant in developing the on-going customer strategy and specific recommendations 
    • Provide strategic direction for Premier Hub clients- determining products/services and benefit plan structure that will assist in mitigating a client’s trend
    • Lead quarterly MCAP activities and drive the Small Group MCAP for customer specific savings or process improvement opportunities and report outcomes
    • Bring newly developed clinical solutions for cost containment to AMT for presentation and adoption by client using data and analytics
    • Coordinate necessary data elements and requirements with Health Analytics Consultant and underwriting to develop targets and manage trend 
    • Provide a detailed review of data and analysis to target specific areas of client trend to focus on effective cost management
    • Organize and lead internal meetings to develop initiatives to address cost:  cross organizational focus with product, affordability team,  clinical operations and others
    • Provide valuation of the financials to determine net cost savings  related to implementation of the targeted initiative (s) and determination if the client is on target to meet trend requirements
    • Analyze status of initiatives implemented and financial performance post implementation at the individual client level (continue to monitor and update the evaluations for proposed cost savings not implemented) 
    • Lead effective business meetings/presentation with the sales and growth team, site leadership, staff and internal/external partners
  • Develop and lead integrated rounds between the clinical team, Optum Rx, Briova, Behavioral Health, Clinical Coverage Review, Inpatient Care Management and Advocates
    • Management of blended census reporting and identification of cases for assignment to clinical team
    • Identification of additional opportunities for management or member outreach based on client specific programs and services
    • Coordinate and lead the daily round discussions for the assigned Premier Hub clients 
    • Assist the team to drive resolution of any escalated member issues and identify opportunities for process improvement to mitigate future escalations
    • Track and value key interventions that lead to client savings
    • Engage additional organizational resources as required (e.g. Network, external business partners specific to the client)
  • Ensure that programs developed are continually monitored for effectiveness and updated/revised as needed to meet objectives
    • Develop and maintain client specific action plans and tracking for each Premier Hub Client
    • Develop client facing tools using applicable data and reports that demonstrate the outcomes of the trend management to the client (e.g. Executive Client Dashboards, Financial Outcome Measures)
    • Analyze data to determine effectiveness of the actions and implement improvement plans as required
    • Evaluate the need for customer specific predictive model (e.g. Hub Rules) and stratification of outreach efforts
    • Monitor and maintain clinical operations and associated functions (e.g. set-up including SBP, SAI, Dialer jobs, engagement targets and performance)
    • Investigate and implement action plans to address any clinical operations deficiencies or defects
    • Own the ongoing operational metrics, clinical outcomes and financial commitments related to the Premier Hub model at a client level
    • Collaborate with customer analytics manager for clinical reporting for client presentations
    • Participate in internal RFP meetings to prepare and present  documentation from the model and incorporate into the discussion or  proposal  
    • Ensure Customer commitments are aligned with service delivery capabilities.  Provide expertise to internal partners (clinical operations, product, etc.) to ensure programs are implemented based on client specific requirements and can be reported on effectively
    • Conduct monthly  meetings with impacted stakeholders to review program status and drive operational performance 

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:

  • Registered Nurse with 5-10 years operations services delivery leadership experience
  • Operational End to End thinker: broad program and delivery modality knowledge
  • Strategic operations leader: able to make decisions and drive execution
  • Relationship management skills: internal (staff, matrixed resources) and external (Customer, carrier, vendor)
  • Ability to lead change and innovation
  • Client facing presentation skills
  • Full COVID-19 vaccination is an essential requirement of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance

Preferred Qualifications:

  • Master-level education in related discipline (business, healthcare) 
  • Excellent conflict management skills
  • Aptitude to assess and identify business gaps
  • Understanding of database structure and processes to query data
  • Microsoft Excel and PowerPoint
  • Solid critical thinking skills
  • Solid verbal and written communication skills
  • Solid ability to multi-task and manage multiple priorities
  • Ability to influence/lead positive change
  • Ability to translate data into meaningful/actionable information
  • Ability to execute flawlessly on operational deliverables, to include developing action plans to accomplish goals and providing ongoing updates on progress.

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment

Careers at UnitedHealthcare Employer & Individual. We all want to make a difference with the work we do. Sometimes we're presented with an opportunity to make a difference on a scale we couldn't imagine. Here, you get that opportunity every day. As a member of one of our elite teams, you'll provide the ideas and solutions that help nearly 25 million customers live healthier lives. You'll help write the next chapter in the history of health care. And you'll find a wealth of open doors and career paths that will take you as far as you want to go. Go further. This is your life's best work.(sm)

Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $97,300 to $176,900. The salary range for Connecticut / Nevada residents is $97,300 to $176,900. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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.

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

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 bylower 48 law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.