Health Services 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.

Rhode Island’s Community Plan’s program serves individuals enrolled in Managed Medicaid and UnitedHealthcare Dual Complete Program. UnitedHealthcare Community Plan of Rhode Island Health Services Director will be responsible for the delivery and management of all covered medical services; Physical Health, Behavioral Health, additional Community Support Services, and Care Management for all Rhode Island Community Plan enrollees.

The Health Services Director (HSD) for the health plan provides strategic leadership and is accountable for all clinical programs for our Medicaid , Dual-eligible, and LTSS members to ensure contractual compliance and achievement of clinical, care management, utilization management, State clinical programs and NCQA accreditation for complex case management goals. The HSD serves as the primary point of contact for clinical programs and is accountable for all aspects of health plan clinical performance.

This position partners with the Chief Medical Officer to identify opportunities to collaborate with providers or implement programs to improve quality, outcomes and reduce the cost of the health plan. This position is responsible to evaluate the clinical and business impact of decisions made by the health plan, other parts of the business and the UHG enterprise. This individual maintains compliance with Rhode Island and federal regulations and contracts and complies with company policies and procedures.

If you are located in Rhode Island, Massachusetts, and/or Connecticut, you will have the flexibility to work remotely*, as well as work in the office as you take on some tough challenges. This will be a hybrid position and will need to commute and work in the Warwick, Rhode Island office location 1-2 days per week.

Primary Responsibilities

• Direct overall local market health plan clinical operations, including achievement of annual clinical, care management, quality/affordability, utilization management and team engagement/experience goals
• Plan, implement, monitor and remediate (if applicable) clinical operations, programs, and strategies
• Local market SME for all clinical/medical management programs and contractual requirements
• Confirm compliance with relevant regulations, procedures, and processes
• Direct the development of well-designed processes that, when fully implemented, will be evident in daily workflows that are efficient and support the achievement of the health services goals
• Direct the integration of the local Quality Management Committee activities into clinical practice
• Oversee the integrity of the case management systems to verify consistency and accuracy and compliance with accreditation and contractual requirements
• Contribute to the development and execution of overall health plan strategies and business goals through active participation in Health Plan Senior Management team meetings, health plan functional meetings and National UHG partnership meetings
• Identify network gaps and access issues and collaborate with Network Management to ensure issues are addressed
• Oversee State specific clinical functions to ensure compliance with State regulatory and contractual requirements and work collaboratively with the CMO, CEO and other leaders
• Actively participate in State and Provider meetings in collaboration with the Health plan leadership and the CMO
• Work collaboratively across all business segments to design and develop innovative programs to impact healthcare quality, access, affordability, population health and health equity
• Coordinate plans with the local and national Quality Committees to comply with regulations and accreditation agencies
• Implement initiatives to meet the needs of enrollees and confirm contract compliance
• Direct the development of results-oriented relationships with contracted facilities and providers including Medicaid Accountable Entities
• Direct the orientation, training and ongoing education and skill development of the health services staff to ensure performance against contractual, regulatory and business requirements
• Participate in and lead special project groups that provide skill-building opportunities for the participants Communicate clinical/medical information to stakeholders
• Relationship lead for State agency clinical program leaders and Medicaid Accountable Entity clinical leaders
  
  

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

• 5+ years of demonstrated care management/population health experience in a large, matrixed healthcare corporation serving Medicaid and/or Medicare beneficiaries
• 5+ years of combined program leadership and managerial experience
• Significant experience in development and execution of clinical programs in public sector managed care environment
• Demonstrated track record of leadership development Intermediate computer skills- MS Office Suite- PowerPoint, Excel, Word
• Demonstrated health care industry knowledge including issues and cost drivers affecting government programs
• Extensive knowledge of business operations
• Demonstrated track record of clinical program compliance, functional collaboration, and meeting program goals
• Reside within a commutable distance to the Warwick, RI office location
• Ability to travel up to 10%
  
  

Preferred Qualifications

• Unrestricted, current Clinical Licensure (e.g. Nursing, Pharmacy, Clinical Social Work) in the state of RI, or the ability to obtain
• CCM Certified
• Experience with LTSS & Foster Care delivery systems
• Project Management experience
• Business and Analytic skills; ability to analyze data and problems/situation to uncover root causes and drive actions
• Proven solid written and verbal communication skills
• All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
  
  

The salary range for this role is $150,200 to $288,500 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 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.