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Manager, UnitedHealthcare Community Plan Operations - Brentwood, TN

UnitedHealth Group

Brentwood, TN
Job Code:
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Job Details

Manager, UnitedHealthcare Community Plan Operations - Brentwood, TN(Job Number:713041)

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)

As the Manager, LTSS, ECF and DSNP Operations, you will have the opportunity to work with the State of Tennessee to ensure success of its programs which are designed to deliver care to individuals who need it most.  You'll get exposure to cross-segment business functions, and influence and drive innovative work that improves the health care system for the benefit of thousands of individuals.


The Manager, LTSS, ECF and DSNP Operations will:

  • Serve as the primary internal point of contact regarding operational matters related to LTSS (CHOICES), Employment and Community First (ECF) and DSNP
  • Be accountable for managing and improving claims payment operations for LTSS, ECF and DSNP lines of business
  • Provide program management and leadership, to ensure that all internal and external stakeholders are informed and contribute to the end result
  • Oversee assigned program activities, including the participation and work expected of internal business partners such as Optum

As part of UnitedHealthcare Community Plan, this role will drive various work streams, lead cross segment initiatives, and support the overall relationship with the State of Tennessee as it continues its journey of transforming the health care system for the benefit of individuals in need.


Primary Responsibilities:

  • Represent UnitedHealthcare in the operational effectiveness of the programs
  • Develop strong relationships with key customers and stakeholders to maintain trust
  • Provide guidance, expertise, and / or assistance to internal and / or external partners (e.g., claims; call center; benefits; clinical) to ensure programs and strategies are implemented and maintained effectively
  • Communicate with and help internal and / or external partners interpret contractual requirements in order to ensure effective problem solution and strategy implementation
  • Ensure internal partners and / or external vendors adhere to business and contractual agreements
  • Review, create, and / or maintain workflows to ensure they are up-to-date and operationally efficient
  • Provide input into, develop, and / or modify policies and procedures
  • Work with internal and / or external partners (e.g., claims; call center) to ensure accurate reports are produced to validate program performance review
  • Predict emerging customer needs and develop innovative solutions to meet them
  • Develop corrective action plans to address and / or resolve relevant internal and / or external stakeholders' concerns or issues regarding operational issues
  • Stay abreast of changes and / or updates in relevant policies, procedures, and regulations
  • Monitor and / or report on-going compliance and related outcomes (e.g., claim denials; complaints) to relevant internal and / or external stakeholders (e.g., regulatory agencies; customers; vendors)
  • Solve unique and complex problems with broad impact on the business

Job General Operations Management
Primary Location US-TN-Brentwood
Other Location 
Organization C&S Tennessee
Schedule Full-time
Number of Openings 1
Apply on the Company Site

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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