Director

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 Director, Complex Pediatric Clinical Strategy will have accountability for the development, execution, and evaluation of the clinical strategy for the complex pediatric population for UnitedHealthcare Community & State. This individual will establish the framework to support a comprehensive approach for the child and adolescent population with complex needs. This framework will advance a suite of solutions that empower members / families, improve the experience for members, drive improved outcomes, reduce costs, promote a sustainable, coordinated provider and community ecosystem, and accelerate growth. This framework will integrate evidence-informed and best-practice strategic solutions, at the care management, provider, individual / family, and systems levels. These strategies will help position Community & State as an innovative leader in this space, allowing for a robust articulation of solutions in competitive rebid and greenfield RFP situations.

In this role, you will serve as a key team member, reporting to the VP Complex Populations Clinical Strategy and Program Development. Your responsibilities will include the development, execution, and operations and financial measurement of the comprehensive clinical strategy and model for complex pediatric population. In addition, you will be a key liaison to leadership through executive reporting, sharing strategy, and partnering with internal / external programs.

This role works with team leaders and matrix partners including Medicaid Clinical Strategy, Medicaid Workforce Management / Training, Clinical Implementations / Adherence, Healthcare Economics, Network, Optum Behavioral Health Services, local health plan leaders, and other functional areas.

This role is responsible for promoting and driving a differentiated set of solutions across 20 Medicaid markets. To keep up with changing trends and member preferences, the Director will advance the adoption of digital solutions to improve member outreach and engagement, accelerating evidence-informed interventions, and designing partnerships with provider and community-based organizations to drive improved health outcomes.

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

Primary Responsibilities :

• Provides leadership to develop and design a comprehensive clinical model and strategy.
• Provides leadership to and is accountable for the performance and direction of assigned programs, managing end-to-end execution and value delivery through partnership management, as well as driving and enhancing existing capabilities, all from inception through launch and measurement stages.
• Owns the relationship with vendor / internal programs, serving as primary point of contact, and maintains positive, productive, open working relationships at all levels.
• Assess evidence base, competitive landscape, population framework, financial drivers, partner strategy and market trends to inform development and improvements to the model.
• Brings forward recommendations and drives to resolution to gain cross-functional alignment and decision-making.
• Evaluates financial forecasting and affordability opportunity in partnership with HCE and matrix partners, socializes with leadership, develops and executes action plans.
• Partner with network team to develop and implement alternative payment models to create greater access to care and drive improved health outcomes.
• Establish evaluation and ongoing monitoring strategies, and analyze relevant data sources to determine program effectiveness, identify improvement areas to enhance efficiencies, and implement process improvement activities.
• Supports the program maturity lifecycle by ensuring smooth and timely program expansion, draw down, or transitions to other programs, keeping data driven approach to monitoring the implementation or draw down plan.
• Proactively develops various communication elements to socialize and align stakeholders regarding projects and statuses to facilitate decision making and understanding with the business and other partners, including develops executive level program summaries and communications.
• Participates and co-leads minimally quarterly performance review Joint Operating Committee meetings (JOCs) with program leaders, may be monthly with immature programs, providing oversight that JOCs are productive, driving agendas, ensuring follow-up items tracked and addressed to completion.
• Develop internal relationships and lead cross-functional engagement (e.g. network, behavioral health, clinical, etc) to support development of strategies.
• Provide thought leadership and serve as SME for business and functional partners.

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

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