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Associate Director, Medical and Clinical Operations - Washington

UnitedHealth Group

Seattle, WA
Job Code:
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Job Details

Associate Director, Medical and Clinical Operations - Washington(Job Number:712237)

The Associate Director, Medical Clinical Operations Washington Site Lead will be directly responsible for the performance of the both the Whole Person Care (WPC) and Health Home Programs. The programs support Medicaid and Dual consumers. In addition, the Associate Director will be accountable to coordinate between the health plan and other linked Optum programs. This person will be accountable for identifying and driving affordability opportunities at the Health Plan level. The person in this role will be the primary liaison between the C&S Health Plan, Optum clinical programs, and Optum Product to provide a continuous feedback loop regarding program performance and State needs. This includes supporting RFPs, Health Plan specific requests to adapt current programs to respond to state compliance requirements/mandates and continuous improvement projects to support affordability goals.  
The ideal candidate will provide strategic and tactical direction to the operational team. Oversight would include teams mobilized to the field and providing telephonic support for our members.
This role works closely with the Community & State Health Plans as well as Optum Product Team and relationship office account management to make recommendations and support ongoing operations for Clinical Management solutions for the Medicaid and DSNP customers. The scope of the position leverages in-depth quantitative skills, knowledge of the unique needs of this membership, Optum operational capabilities, and an understanding of key business objectives. 
Primary Responsibilities:
  • Primary Optum Clinical Programs Operational Leader
  • Build strong relationships with key C&S Health Plan clinical leaders
  • Responsible for ensuring the reporting of program metrics
  • Lead innovation by proactively making recommendations on program design as needed to ensure program performance at or exceeding set targets
  • Working across other functional areas (operations, reporting, analytics, finance, product etc.) to support the execution of the program strategy
  • Coordinate with other Optum programs such as Specialty Networks (Behavioral, Complex Medical Conditions, Physical Health) and Complex Population Management as needed
  • Support implementation of WPC model within the Health Plan per national implementation schedule
  • Work with reporting and operations to monitor Optum performance at the Health Plan level. Present results at Monthly Business Review with Regional Plan leads
  • Make operational adjustments to ensure programs are performing at or exceeding set targets
  • Drive affordability within the Health Plan; participating in affordability reviews and action planning for the Acute Medicaid and DSNP membership
  • Partner on all custom/non-standard requests made by the Health Plan, collaborating on the governance process designed to address which actions will be carried out and by when
  • Represent care management programs during state audits
  • Supports the team to ensure compliance with state regulatory requirements, quality and HEDIS standards and ISO compliancy
  • Other duties as assigned by management

Job Med & Clin Ops-General Mgmt
Primary Location US-WA-Seattle
Other Location 
Organization Optum Ops-PHM Medicaid
Schedule Full-time
Number of Openings 1
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UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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