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)The Associate Director of Risk Adjustment Services is responsible for managing and overseeing the end-to-end execution of Retrospective services within the Risk, Quality and Network Services (RQNS) segment. The Associate Director will be responsible for creating, maintaining and publishing P&L forecasts for all assigned services. Management and oversight of multiple levels of matrixed staff and multiple functions / departments across one or more business units will be required. The Associate Director will develop and implement service enhancements or ideate new services as required. This person will work across multiple operational teams to ensure proper establishment of services and operational excellence. The Associate Director will provide leadership to manage service definition, requirements creation, operational and technical considerations, pricing, contracting, and operational effectiveness oversight to ensure proper execution of services. Further, this individual will solve for complex business issues and represent the concerns of RQNS and the client in escalated management, legal, compliance and client satisfaction issues.You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.Primary Responsibilities:Owns end to end process for assigned servicesFunctions as subject matter expert to client facing teams, sales and internal resourcesIdentifies and resolves technical, operation and organization issues. Escalates to Senior Management as appropriateMonitors project performance against established service level agreements to determine overall effectiveness of program (add the oversight / creation of SLRS). Makes necessary changes and identifies opportunities for new programs, program consolidation, efficiencies or expansions to existing programs / servicesCreates, reviews, and maintains operational workflows to ensure they are up-to-date and operationally efficient. Maintains appropriate internal and external documentation as necessary for each assigned serviceMonitors appropriate controls for each process / handoff within the service to ensure adherence to compliance requirementsAssists and provide necessary information/inputs (volumes, vendor cost estimates, resource estimates) for accurate pricing of services as well as risk management protections and caveats Manages P&L for assigned services and generates required financial documentation for revenue projections and CBA'sDemonstrate understanding of and adhere to relevant policies, procedures, and regulations for assigned servicesStays abreast of changes / updates in all relevant policies, procedures and regulations within the risk adjustment segment (Medicare Advantage, Affordable Care Act, Medicaid) Provides training and education to internal stakeholders on relevant policies and procedures to ensure proper execution of serviceCommunicates and coordinates with and/or helps internal / external partners interpret contractual requirements in order to ensure compliance with contractual and regulatory stipulationsWorks with other key business, product and strategy team members to enhance and implement changes to existing or new services as appropriate/necessary. Develops and assists in creating pilots and/or POC's (Proof of Concepts) necessary to provide strategic direction for new services
Required Qualifications 3 or more years of understanding of Medicare Advantage and/or Affordable Care Act (ACA) risk adjustment principles and concepts 2 or more years of client facing experience 1 or more years of experience knowledge of Federal submission requirements to CMS and HHS Experiencing with managing a budget and/or P&L Intermediate Proficiency Excel and PowerPoint Travel up to 10% Preferred Qualifications Undergraduate degreeUnderstanding of Risk Adjustment programs and their interdependency with CMS and HHS submissions requirementsProduct or strategy experience in either healthcare, insurance, and/or risk adjustment fieldsExperience with chart review (prospective and/or retrospective) processes including but not limited to: suspecting, targeting, retrieval, coding and quality assuranceBasic underwriting, pricing and /or risk management principles Project / program management experienceSoft Skills:Multi-tasking, ability to manage at macro level and also dig deep into issues for successful resolutionStrong written and verbal communication skillsRelationship management skills; ability to communicate sensitive information in a positively received fashion. Ability to build and maintain relationships inside and outside the organization via telephonic meansCareers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm) *All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy. 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: Prospective, Retrospective, Medicaid, Telecommute, Medicare Advantage and/or Affordable Care Act (ACA), Risk Adjustment, Telecommute, Remote, Work from Home
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.