Sr.Vice President, Enterprise Care & Value Clinical Operations

Company: UnitedHealth Group
Location: San Antonio
Posted on: November 22, 2021

Job Description:

Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life's best work.(sm)Provides strategic direction, leadership and oversight for ECV programs for UM, UMMD, & PHM. Responsible for planning, organizing, and directing administration for UM, UMMD, & PHM programs. Provides leadership to & is accountable for the performance & direction through multiple layers of mgmt and senior level professional staff. Responsible for coordinating with appropriate personnel to meet operational program needs, ensures compliance with state/federal health plan requirements, Medicare guidelines, NCQA & health plan requirements. Provides longterm planning and oversight to ensure activities are appropriately integrated into strategic direction & operations, as well as the mission and values of WellMed/OptumCare.VP of Clinical Ops works closely with WellMed & Regional executive leadership to achieve goals & objectives of the Program.The Enterprise VP of Central Care Management Operations works closely with WellMed Executive Leadership and the Regional Care Management leadership as well as the Regional Dyads to achieve the goals and objectives of the Enterprise Care Management Program.Primary Responsibilities:

• Designs and directs UM, PHM, UMMD program descriptions, work plans, program evaluations and overall Model of Care.
• Directs the development, planning and execution of continual process improvement efforts, policies, procedures, and regulatory compliance functions related to care management activities.
• Assists with the development of the UM Work Plan, Evaluation and the monitoring of the Work Plan activities as they related to clinical performance improvement
• Provides vision and leadership to advance the PHM program under WellMed to the next level of service.
• Collaborates with physician leadership to execute the implementation of the UM, PHM, UMMD programs as defined by Enterprise as well as Optum.
• Promotes understanding, communication and coordination of all UM, PHM, UMMD programs components with regions and their leadership.
• Provides oversight for all activities related to delegated and regulatory requirements including annual health plan delegation audits.
• Drives adoption of best practices and trends for UM, PHM, UMMD activities
• Participates in health plan CMS audits
• Monitors/analyzes metrics/data/trends, and ensures areas needing attention are communicated to applicable stakeholders
• Drives UM performance to meet targets for admissions, readmission and total health care costs for the organization
• Develops operating budget as necessary and participates on various teams, committees and meetings at WellMed and Optum.
• Designs and directs configuration for UM, PHM, UMMD core application system
• Drives and assists in the design of strategic plans and management of enterprise-wide, large-scale clinical initiatives, pilots, and projects promoting quality care for seniors.
• Directs and oversees innovation initiatives, data analysis activities, and evaluation strategies for clinical programs including, but not limited to, pilot projects, grant-funded research projects, and publication endeavors related to the population we serve in multiple markets.
• Develops strategic partnerships, joint ventures and learning opportunities with medical academies/associations, academic institutions, and organizations with local, national and global impacts to population health.Required Qualifications:
  • Registered Nurse (RN) degree and/or Licensed Clinical Social Worker with minimum of 10 years experience in practice; Active and unrestricted license to practice in any US state
  • Master's degree in Healthcare or Business Administration preferred (10 additional years of comparable work experience beyond the required years of experience may be substituted in lieu of a Master's degree). Demonstrate knowledge of the business environment and business requirements (e.g., strategy changes, emerging business needs).
  • Fifteen or more years of management-level experience in managed care, medical management programs required, including five or more years of experience at the Director level or above. Ability to manage up, laterally, and within non-traditional matrix structures by influence
  • Proven capability of working with people at multiple levels of the organization, across multiple locations, multi-function.
    • Excellent training and collaboration skills; excellent verbal, written communication, presentation, and facilitation skills; presentation SME with market level interface
    • Knowledge of fiscal management and human resource management techniques; proven evaluative and analytical skills; ability to analyze data/reports and make recommendations.
    • Demonstrates knowledge of the business environment and business requirements (e.g., strategy changes, emerging business needs)
    • Knowledge of federal and state laws and NCQA regulations relating to managed care and delegation, and all aspects of Medical Management.
    • Ability to establish and maintain effective working relationships with employees, managers, healthcare professionals, physicians and other members of senior administration and the general public.
    • Exceptional organizational, detail and accuracy skills
    • Ability and willingness to travel 25% and non-locally as determined by business need.
    • Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance

Keywords: UnitedHealth Group, San Antonio , Sr.Vice President, Enterprise Care & Value Clinical Operations, Executive , San Antonio, Texas