Health Services Director

About the position 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. Health Service Director careers at UnitedHealth Group are anything but ordinary. We push ourselves and each other to find smarter solutions. The result is a culture of performance that's driving the health care industry forward. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Because of the unique structure and alignment of clinical programs within United Healthcare, the HSD 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, Behavioral Health, and other clinical specialty, external vendors or national programs. This position will report to the CEO of Louisiana C&S. If you are located in Louisiana, you will have the flexibility to work remotely as you take on some tough challenges.

Responsibilities

• Have oversight of Louisiana Clinical operations and the day-to-day activities of their managers and clinical teams and owns the end-to-end process
• Implement program structure and resource plans for Louisiana Medicaid populations serviced under the Healthy Louisiana program run by the Louisiana Department of Health(LDH)
• Ensure clinical processes, policies and procedures meet regulatory standards and are consistent with the national clinical model
• Lead, coach, and develop clinical leadership staff, foster innovation to improve member outcomes
• Identify and drive local Healthcare affordability initiatives along with medical directors and clinical teams
• Ensure monitoring and oversight of clinical programs/staff to meet defined goals, targets and regulatory requirements
• Work collaboratively with providers, other business segments, service contractors and health plan management to oversee health services department with the objectives of improving the quality of care delivered to members, improving cost efficiencies, and developing an environment of operational excellence
• Interface with UHG enterprise to ensure clinical operations are compliant with State and Federal regulations
• Collaborate with internal and external entities to improve accessibility standards and quality practice standards
• Develop, interpret and execute strategies or functional / operational objectives for Health Plan including medical management, financial accountability, customer and provider satisfaction and quality improvement
• Proactively develop and implement staff retention and engagement program
• Regularly interact with Health Plan Senior leaders and State Regulators on clinical and service issues
• Collaborate with CMO and COO to develop effective clinical strategy for the plan
• Ensure clinical staff training, onboarding, immersion and competency assessment processes meet contract requirements and clinical model standards
• Coordinate and provide oversight for all clinical programs delivered by multiple business segments / external vendors to ensure Health Plan goals are met
• Identify and implement best practices, barriers and potential solutions when operational processes or clinical programs are not delivering results
• Effectively plan and lead large scale clinical program deployment and new business implementation
• Manage over 50 FTEs in multiple geographic locations within the state
• Commute to the Metairie and Baton Rouge, LA office locations for meetings

Requirements

• Active RN licensure in State of Louisiana
• 5+ years progressively responsible healthcare leadership
• 5+ years Care Management/Utilization management experience
• Experience working in Medicaid managed care
• Health Plan Experience
• Basic or higher level of proficiency in Microsoft Office Suite including Excel, Word, Outlook, and Access

Nice-to-haves

• Case Management Certification
• LTC knowledge
• Louisiana Statewide Medicaid Managed Care program knowledge

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution

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