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

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 the state of Washington or within commutable driving distance, you’ll enjoy the flexibility to work remotely * as you take on some tough challenges. 

 

Primary Responsibilities:

• Management onboarding, training and support
• RFP Development and implementation for Washington market
• Provide leadership oversight by ongoing & annual evaluation of the 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
• Partner with the compliance leads and adherence teams on all compliance-related topics, and ensure, from a clinical operational perspective, there is compliance with all clinical care management and documentation requirements, policies, and procedures
• Support with clinical internal and external audits and accreditation activities
• In partnership with the Quality team, develop a work plan geared towards continuous quality improvement inclusive of clinical care management operations and performance
• Assist Director with establishing MBOs for Care Management team that align with QD and CMO MBOs
• Share, support and implement remediation plans to ensure DSNP MOC and NCQA Care Management adherence
• Implement C&S clinical operations models and monitor performance
• Collaborate with national affordability team to strategize and remediate clinical affordability projects
• Serve as the lead between health plan  and national support functions, including requests for program changes, implementation, training, etc., balancing local customization with national scale programs and efficiency
• Understand state and federal legal and contractual complex care case management regulations and requirements; translate requirements into operational metrics and protocols
• Accountable for ensuring clinical remediation plans are developed and successfully implemented for corrective action plans
• Drive collaboration as the lead for the health plan with shared service partners to use audit and reporting metrics to ensure performance against contractual and regulatory requirements

 

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:

• Active, unrestricted RN license in the state of Washington
• 5+ years of equivalent professional experience
• 3+ years of healthcare experience including Managed Care experience, healthcare administration and or healthcare consulting experience
• 3+ years of experience within healthcare operations, clinical services, network, products, and benefits
• 3+ years of leadership and managerial experience
• Experience working closely with state regulators
• Driver’s License and access to reliable transportation with the ability to travel locally up to 25% of the time

 

Preferred Qualifications:

• Supervisory clinical experience
• Experience with financial affordability
• Customer-focused; proven ability to handle complex situations, resolve conflicts and issues effectively. Sensitive to how people and the organization function
• Demonstrated ability to translate strategic objectives into action plans and lead / motivate teams to execute plans effectively; flexibility to adapt and change direction as needed
• Reside in the state of Washington
   

*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 al 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.

 

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.