Associate Health Services Director - Remote in NJ, NY, DE or PA

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 Associate Health Services Director (AHSD) works under the direction of the Executive Director of Health Services and provides strategic leadership and is accountable for all clinical programs for all products and memberships served by the health plan to ensure contractual compliance and achievement of clinical management goals. This includes TANF, ABD, Complex Care or LTSS, CHIP and DUAL Medicare programs, as well as members with Developmental Disabilities.

The AHSD serves as the primary point of contact to the clinical and non-clinical teams and is accountable for all aspects of the health plans clinical performance. Because of the unique structure and alignment of clinical programs within United Healthcare, the AHSD role requires a high degree of coordination with external and internal business partners, including, but not limited to the UHC-Clinical Services inpatient and Intake/Prior Authorizations, Appeals and Grievance, Quality, Optum case and disease management, Healthy First Steps, NICU, Optum Behavioral Health, state Medicaid partners and other clinical specialty, external vendors or national programs.

The AHSD must work collaboratively with the health plans, Director of Health Services, Director of Quality and plan Medical Director to support achievement of state quality initiatives, state mandated programs and to ensure compliance with relevant requirements of the state?s annual Performance Review(S) conducted by the External Quality Review Organization (EQRO), state or other oversight body and meeting NCQA requirements.

If you are located within the state of New Jersey, New York, Delaware, or Pennsylvania, you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities

Is the local market SME for all clinical/medical management & state mandated programs (DCP&P, Lead, Healthy First Steps & Private Duty Nursing) and contractual requirements
? Lead, coaches / develops, trains (in conjunction with clinical learning team) and supports health plan based clinical team. Ensures effective, compliant, clinical program delivery, monitors performance and clinical outcomes
? Contribute to the development and execution of overall health plan strategies, Winning Priorities Key Initiatives through active participation in Health Plan Sr Leadership/Operations meetings and health plan functional meetings
? Foster and promotes two-way communication and information sharing necessary for successful clinical program implementation. Is the Primary liaison to clinical business partners both internal and external for member/clinical issues such as the state Medicaid agency, Optum HFS/ NICU, Optum Care Solutions which includes Case Management and HARC, Prior Authorization, Intake, UBH, Appeals & Pharmacy Departments- point of contact for reporting, troubleshooting, case reviews, member complaints and issues requiring local health plan support
? Identify network gaps and access issues and participates in local market Network Management Governance meetings to ensure issues are addressed
? In conjunction with medical director, ensures regularly scheduled interdisciplinary team meetings and processes are in place to address member and provider issues/needs
? Lead in collaboration with UHCCS and Optum business partners in audits such as the External Review Quality Organization Audits for clinical programs which may include developing/owning program material binders, policies and responses
? Conduct regular staff meetings with local Health Services staff and service partners as appropriate, to exchange corporate and health plan information/updates; address staff questions and concerns, etc.
? Ensure timely communication of any new contractual requirements and audit findings
? Implement team initiatives associated with making UnitedHealthcare a great place to work, including embracing Our United Culture and sustaining a highly-engaged work force as measured by the annual VitalSigns Survey
? Oversee State specific clinical functions to ensure compliance with State regulatory requirements and works collaboratively with the Clinical Adherence team to ensure adherence with regulatory and contractual requirements
? Respond to all State and Regulatory agency inquiries and member grievances
? Understand the clinical services for Medicaid and Medicare line of business and/or cohorts contracted within the Health plan including Complex Care programs, as well as members with developmental disabilities
? Attend regularly scheduled UM rounds to assist with removal of barriers to members with complex discharge needs and address any other barriers
? Conduct performance reviews with all clinical and non-clinical staff
? Attend State Meetings as necessary
? Conduct onsite-supervision of staff members home visit with members
? Other duties as assigned

Compliance / Adherence (Measured by adherence monitoring results, CAPs, Fines, Sanctions related to CM, UM, DM)
? Ensure adherence to state contracts for all medical management/clinical requirements and holds business partners/shared services teams accountable for compliance
? Has monitoring and controls in place to regulatory measure and monitor performance with staff
? Identify and addresses any contractual risks early and implements a performance improvement plan with CM and UM partners to become contractually compliant
? Communicate timely, any changes in clinical contractual requirements, Clinical CAPs, sanctions or fines to National Med Mgt Leaders/Business Partners and ensures changes are made to business processes to adhere to changes requirements
? Work in partnership with local compliance to support Medicaid and Medicare (if appropriate) Fair Hearing and SAP Process
? Knowledge of each line of business(Medicaid, Medicare, Developmentally Disabled) and cohort operation results and develops improvement plans as appropriate

Customer Relationships (Measured by observation, feedback from external customers and Vital Signs Engagement scores)
? Actively participates in State and Provider meetings in collaboration with the Health plan leadership, Director of Health Services & CMO
? Actively participates in community outreach and networking activities to develop support and community infrastructure to meet member needs, promote membership growth and retention
? Work with Health Plan Medical Director to establish strong provider relationships,
? Fosters/supports social responsibility activities within the Health Plan/UHG and local community
? Actively embraces United Culture and Values in working with both internal and external customers/partners
? Participate in member advisory boards as appropriate for all lines of business i.e. Medicaid and Medicare

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
? Clinical experience with Medicaid/Medicare populations
? Demonstrated track record of clinical program compliance, functional collaboration, and meeting program goals
? Demonstrated track record of leadership development
? Intermediate computer skills - MS Office Suite: PowerPoint, Excel, Word

Preferred Qualifications
? A Registered Nurse having at least 5+ years of experience providing care coordination to persons receiving Medicaid services and an additional 3+ years of work experience in managed care
? CCM Certified
? Medicaid Managed Care experience
? Field based case management program implementation and monitoring experience
? All employees working remotely will be required to adhere to UnitedHealth Group?s Telecommuter Policy

New York or New Jersey Residents Only: The salary range for this role is $104,700 to $190,400 annually. 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.

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