Provider Enablement Value-Based Care – VBC – Population Health and Clinical Quality Director – Remote

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

The VBC Population Health and Clinical Quality Director for the Provider Enablement Methods & Data Science team provides clinical expertise and guides the direction of clinical best practice and population health interventions within the Provider Enablement product roadmaps, leads client collaboration meetings, and provides clinical oversight of the methodology behind the products. This position will develop clinical decision-making logic that will be applied across a suite of products that illuminate healthcare costs and clinical quality across the entire clinical enterprise, with particular focus on clinical quality measurement.

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

Primary Responsibilities:

• Develop novel healthcare quality measures by staying informed of industry changes and collaborating with internal and external clients and physician consultants
• Leverage clinical expertise to elevate, innovate, and advance healthcare analytic products and consulting projects in value-based care
• Client-facing role will support sales and renewals by engaging with current and prospective clients, offering detailed insights into the clinical logic within the quality product area
• Lead clinical discussions with an external panel of specialty physician consultants to design clinically appropriate quality measures
• Drive innovation in the quality measure space by developing point of care measures and actionable opportunities to support VBC contracts and drive reduction in total cost of care while ensuring best practice
• Ensure AI/ML solutions align with real-world clinical experience of providing patient care and operational considerations to center our products around optimal patient outcomes; provide clinical expertise for these solutions for applications in automating population health interventions and optimization of care management workflows
• Thoroughly research and examine diagnosis, procedure and laboratory codes (e.g., ICD10, CPT, LOINC) with pharmacy claims to establish clinical definitions that drive quality measurement, AI tools, and ML models
• Develop novel methodologies in existing analytics/products and new decision-support applications
• Lead or contribute to efforts to write peer-reviewed publications, white papers, and other dissemination projects that highlight the use of our advanced analytics solutions
• Promote a culture of clinical excellence for the company and its AI/ML and quality-based solutions

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:

• Nurse Practitioner or Physician Assistant or equivalent with an active, unrestricted license
• 5+ years of experience as a practicing clinician in the United States
• 5+ years of experience in the use and application of claims and clinical (electronic health record) data-based analytics
• 3+ years of experience with healthcare quality measurement in the United States.
• Knowledge of Value-Based Care programs and initiatives 
• Familiarity with administrative claims data and medical coding systems (i.e., CPT, HCPCS, ICD-9, ICD-10)   Demonstrated ability in written and verbal communication and presentation skills with clients

Preferred Qualifications:

• Experience participating in, managing or designing Value-Based Care programs and initiatives 
• Experience with population health interventions and/or care management workflows
• Experience with, or directly used, any tool within Symmetry Suite or Impact Suite analytic applications
• Interest in or experience with machine learning and/or artificial intelligence methods
• Experience with risk-adjusted quality measures and payment tools
• Experience with clinical data from EMR to optimizing health care solutions (e.g., clinical decision support systems, care management programs)
• Experience networking within your area to build relationships and further business opportunities 
• Knowledge and/or experience in cost/utilization measurement, bundled payments, or episode groupers
• Knowledge and/or experience in quality measures (e.g., STARS, HEDIS, State measures)
• Demonstrated ability to develop new analytics to meet market needs
• Proven basic skills using industry-standard data analysis tools such as Microsoft ACCESS, EXCEL, or SQL
• Proven interpersonal skills and ability to work cohesively in a team environment
• Proven organizational skills (e.g., prioritize and manage multiple tasks, meet deadlines, complete complex long-term projects) 
• Proven to published in peer-review journals 

*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 all 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.

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.