Director of Medicare and Retirement Medical Policy

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.

UnitedHealthcare Medicare & Retirement is focused on serving Americans over the age of 50. It is the largest business dedicated to meeting the growing health and well-being needs of aging individuals in the nation, serving one in five Medicare beneficiaries through a comprehensive and diversified array of products and services through four industry-leading businesses.

Together, we are removing the barriers that keep people from receiving the kind of quality health care that makes a difference. We focus on Integrity, Compassion, Relationships, Innovation and Performance as we empower people to achieve better health and well-being.

This Category team is charged with improving the quality of medical care through the development of medical policies that apply to Medicare and Retirement, meeting CMS Final Rule requirements that apply to medical policies and overseeing the UHC Medicare Medical Policy Committee. This team uses clinical evidence and Medicare regulations to develop internal coverage criteria to improve quality and outcomes. The position reports to the Medicare and Retirement Medical Policy Medical Director and supervises the Medicare and Retirement Medical Policy Team.

This role will require a critical thinking mindset with the ability to handle multiple priorities as well as the ability to drive implementation of initiatives with the support from Enterprise executive leaders to operational support teams. It also requires a strong knowledge of Medicare regulations.

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

Primary Responsibilities

• Managing and supervising deployment of CMS Medical Policy Regulations in collaboration with internal and external teams.
• Oversee and manage the team that implements Medicare and Retirement Medical Policies with a broad range of internal and external partners.
• Build and develop relationships across teams to ensure effective support and feedback is obtained and deliverables are met
• Partner closely with other Medical Policy teams, Operations, Legal, Regulatory, Delegation Oversight, Compliance and Utilization Management teams.
• Use problem solving skills and make decisions to implement quality improvement initiatives
• Ensure progress reports are processed efficiently and accurately in line with the Department progress report schedule
  
  

Partnership Skills

• Develop and maintain strong relationships with internal and external committee members
  
  

Research Skills

• Ability to serve as Subject Matter Expert and provide guidance to Medical Policy and other areas in matters related to Medicare and research of the Clinical Evidence
• Ability to search for, analyze and present innovative ideas regarding implementation of clinical programs
  
  

Presentation Skills

• Create high-quality Power Point presentations
• Speak clearly on complex problems across a wide range of audiences including but not limited to CMS during audits
• Provide regular updates regarding the development of Medical Policies
  
  

Administrative Skills

• Develop tracking mechanisms to achieve established Departmental goals
• Develop tools such as decision-trees for the team
• Identify process improvement initiatives and propose solutions to leadership
  
  

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

• RN with previous experience in clinical setting
• 5+ years of experience in Medicare Medical Policy and/or Utilization Management
• Prior management experience
• Broad knowledge of Medicare regulations including Medicare Manuals, NCDs and LCDs
• Solid strategic, analytic and critical thinking skills with proven ability to use clinical, administrative and claims data to identify opportunities
• Solid history of quickly building relationships, collaborating across multiple distinct business groups
• Proven success in team development and management
• Proven ability to drive, lead and communicate change effectively in a fast-paced environment and be adaptable within the changing environment
• Ability to make strategic, operational and administrative decisions in response to emerging conditions and environmental circumstances
• Ability to provide recommendations and insight regarding process improvements
• Ability to manage programs and projects in a strategic and professional manner
• Solid ability to communicate effectively and efficiently (both verbal and written)
• Ability to motivate, mentor and influence others at all levels within the organization
• Solid organizational, management, administrative and human relations skills, and a style which exhibits emotional maturity, leadership, collaboration and teamwork
• High level of proficiency with Outlook, MS Word, Excel, PowerPoint and Visio
  
  

Preferred Qualifications

• Coding certification
• Medicare Administrative Contract experience
• 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 al 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.

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.