Sr. Director, OptumCare Core Configuration

UnitedHealth Group - Eden Prairie, MN

Full-time | Custom_1
Let’s talk about meaningful work, an important role and a career move that can transform your future. OptumCare, part of Optum and the UnitedHealth Group family of businesses, is a nationwide health care delivery organization that is reinventing health care, unlike anyone else in the market place, to help keep everyone healthier and feeling their best. In all we do, we are committed to the quadruple aim of improving patient satisfaction, lowering costs, delivering quality outcomes and increasing provider satisfaction. We invest in and partner with doctors and other providers who are looking to embrace a better way of serving and caring for their patients. Taking advantage of our resources, expertise and technologies, we help physicians and other care providers bring better care and service to the people of their local communities-resources that physician practices can rarely afford to build, deploy or maintain on their own. 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 Sr. Director of OptumCare Core Configuration Team is responsible for ensuring that the OptumCare Claims Platform (Facets) is configured accurately and timely. It is their responsibility to ensure member benefits are configured accurately and providers are set up timely. Finally, this department is responsible to maximize the system’s ability to accurately adjudicate the claims based on our contractual commitments to our provider community. The Director will be also be accountable for the development and execution of our strategy and roadmap for all aspects of benefit and provider setup and configuration, change readiness and testing, business technology and business controls. In addition to accountability of Facets configurations, this role will also have accountability for Provider Data Management for the businesses that we support.

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:
Exceed Market Expectations through innovative solutions with a primary focus on improving constituent experience and regulator perception
Simplify, automate and innovate within Configuration and PDM Operations processes end-to end
Lead the Core configuration function and ensure high quality and effective processes are enabled by our team
Leverage functionality provided by Facets and surrounding ecosystems to improve auto adjudication and accuracy of benefit & provider configuration and provider data management
Working with Market Network teams, drive, develop and influence a PADU (Preferred, Acceptable, Discouraged, Unacceptable) list for provider contracts
Lead and direct team to assess benefit and/or provider contract requirements, design solutions that would best utilize the configurability offered within Facets
Ensure that all configuration is designed, built and tested in the available lower environments prior to deploying to production
Create a contract audit capability for initial and renewing contracts to align intent and claim outcomes.
Build end to end testing capability through advanced analytics, system controls and strategic provider partnerships
Leverage advanced analytics to detect potential claim denials and build interventions through controls and provider outreaches to improve provider experience
Lead the provider data management function including working with Health Plans to ensure the provider data is reconciled with their systems
Develop and institutionalize a provider attestation approach and capability to maintain accurate provider data
Execute against inventory and timelines for all aspects of loading with operational discipline for efficiency, consistency and quality
Provide leadership in the areas of program management, program scope definition, risk identification/mitigation, resource allocation and financial management
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:
Associates degree
5+ years of increasingly responsible Configuration leadership experience in the health insurance industry
5+ years leading large, multi-function Facets c teams/projects with deep understanding of both Benefit and Provider configuration
10+ years leading direct operations with inventory management, process, quality and measurement system disciplines
Ability to provide advance analysis, problem solving, and interpret application configuration
Well versed in Facets application functions
Strong analytical skills with ability to drive transformational, consumer-centric change and manage long-term programs
Demonstrated results with simplify, automating and innovating complex processes
Experience with strategic, consumer-centric initiative development and implementation, including operating policies and procedures, and work process improvements
Strong verbal, written, interpersonal and presentation skills required. The proven ability to collaborate and influence internal and external business partners is essential
A proven track of building and fostering relationships at all levels of the organization
Demonstrated ability to lead and develop leaders
A track record of driving high employee engagement and lowering attrition
Intermediate or better proficiency working in MS Word, MS Excel, MS PowerPoint, and MS Outlook
Ability to travel up to 50% (largely dependent on where the successful candidate lives)

Preferred Qualifications:
Bachelor’s or Master’s degree (MBA/MPH/MHA)
Deep understanding of healthcare operations and regulatory expectations of state agencies and programs as well as CMS
Experience working in a highly regulated industry
Strong operational focus with demonstrated project management, change management, and execution skills
Self-motivated and able to work with little direct supervision and drive results with disciplined follow-though
Strong strategic thinking and business acumen with the ability to align people related strategies and recommendations with business objectives
High integrity with a reputation of a trusted confidential adviser and partner
Strong decision making skills including prioritization of capital investments and business change controls
Communicates effectively to the highest levels of leadership
A passion for and commitment to a consumer and client driven culture

OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare’s support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.

  • All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment