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Director Medicare Operations - Telecommute within Ohio

UnitedHealth Group

Westerville, OH
Job Code:
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Job Details

735142 Director Medicare Operations Telecommute within Ohio

Director Medicare Operations - Telecommute within Ohio (735142)

Position Description

If you want to achieve more in your mission of health care, you have to be really smart about the business of health care. Challenge yourself, your peers and our industry by shaping what health care looks like and doing your life's best work.(sm)


Primary Responsibilities:

  • Perform analyses to help drive product strategies (SWOT analysis, competitive positioning, financial, etc.)
  • Oversee internal and/or external business partners with completion of tasks and resolution of strategy driven opportunities (RAF, STARS, claims, call centers, network, etc.) 
  • Oversee the review, creation, and/or maintenance of operational workflows to ensure they are up-to-date and operationally efficient
  • Provide guidance, expertise, and/or assistance to internal and/or external partners (e.g., claims; call center; benefits; sales; quality; clinical) to ensure programs and strategies are implemented and maintained effectively
  • Monitor performance against internal and/or external service level agreement
  • Attend regular meetings (e.g., JOCs; QBRs) with relevant internal and/or external stakeholders to review and discuss updates and outstanding issues (e.g., project implementation readiness; compliance and/or quality audit results; out-of-compliance issues; staffing issues)
  • Conduct deep dive program reviews with relevant internal and/or external stakeholders to identify opportunities for continuous improvement
  • Partner with relevant internal and/or external stakeholders to develop and/or review potential operational strategies, programs, and plans (e.g., affordability initiatives; quality programs; projected resource needs)
  • Monitor project performance against internal and/or external operational service level agreements
  • Ensure regulatory changes are assessed for impact and implemented
  • Work with STAR lead on operational issues impacting CAHPS / quality reporting
  • Work with retention team and other member/provider touchpoints to analyze and resolve root cause operational challenges and opportunities for efficiencies
  • Compile reporting and dashboards for monitoring performance
  • Work with reporting team and other departments for accurate regulatory reporting
  • Ad hoc reporting to identify opportunities for affordability, process improvements
  • Produce ongoing reporting from multiple systems for tracking/trending issues

Required Qualifications:  

  • Bachelor’s Degree
  • 5+ years of leadership experience
  • 3+ years of Medicare or Long Term Care experience
  • Management experience in a health plan or functional area (Product/Operations) experience
  • Critical thinking; analytical skills
  • Knowledge of Medicare operational guidelines (such as claims, appeals and grievances, call center)
  • Health insurance or government programs or non-profit (such as A.A.A.) experience

Preferred Qualifications:  

  • MBA

Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.(sm)


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.



Job Keywords: medicare, medicaid, healthcare operations, managed care, SNP, Columbus, OH, Ohio, product, medicare product, DSNP

Job Details

  • Contest Number735142
  • Job TitleDirector Medicare Operations - Telecommute within Ohio
  • Job FamilyBusiness Operations
  • Business SegmentCommunity and State

Job Location Information

  • Westerville, OH
    United States
    North America

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelDirector
  • ShiftDay Job
  • TravelNo
  • Telecommuter PositionYes
  • Overtime StatusExempt

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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