Executive Director - Medicare & Retirement- Remote

Requisition Number: 2344220
At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.
As an Executive Director, you will serve as the liaison between many internal departments for the local field team for Medicare and Retimrenet (M&R). Manage daily M&R member and provider issues while working with multiple levels of staff on field team and multiple functions/departments across one or more business departments. May have day to day contact with sales, network, enrollment, product and customer service along with provider groups external to the organization.
You will enjoy the flexibility to work remotely * from anywhere within the Pacific, Mountain, or Central time zone as you take on some tough challenges. Expect to spend about 35% of your time in the assigned market.
Primary Responsibilities:

• Must be familiar with CMS covered benefits, rules and regulation. UHC product offerings, footprint and competitor landscape.
• Member facing materials - ID cards, ANOC, EOC, Formulary, CMS standard letters for terming providers or network changes and member education campaigns.
• System set up for NICE and COSMOS - PMG loading, PNI, DIV/Panels, directory flags, PCP panels, network numbers.
• Provider contract set up and offerings - Capitation, delegation, risk, FFS, MAPCPi/MCAIP, ACO, MAIP.
• Basic knowledge of STARs, CAHPS, HOS, RAF.
• Sales point of contact for member related issues, questions or market disruptions. Support AEP efforts with PCP IDs for applications and in/out of network providers.
• General reporting management for business partners - member totals by H plan, county, provider group, TIN or delegate.
• Assist UHN and roster managers with provider loading and accuracy of information. Sign off on loading instructions, source of truth and breakout documents.
• Involvement in provider facing JOC meetings to discuss market performance, strategy around STARS, CAHPS, HOS and RAF. Partner with internal teams of QFO, ACO and Optum to drive goals.
• Involvement in product development and selection of expansion counties or service area reductions.
• Deeper involvement in affordability topics, point of contact for clinical partners like NaviHealth, Sound, DispatchHealth, HouseCalls and Care Connectors.
• Management of CTM and NPS performance and impact to operations/STARs.
• SME to customer service/MAOM escalated issues.
• SME to UHN for M&R provider and system set up. Must be familiar with market nuances and product offerings that cross county lines.
• ACO reporting set up and management of financial statements, eligibility files, MMR/MOR/MAO files.
• Community meeting representation for health plan - new to Medicare meetings, sales AEP meetings, member education events or provider forums.
• Basic understanding of market financial performance.
• Assist with delegation oversight committee - provider prep, system loads and member impact
• New business development for market entrants and contract negotiations for MAPCPI, ACO, and global capitation. Partner with internal contracting, finance, and legal teams to develop and maintain competitive agreements for UHC MA.
• Develop benefit offerings and build market strategy for each product focusing on member growth, retention, and expansion. Lead market discussion for in-depth understanding of all competitors, industry trends and market dynamics.
• Lead all market strategies for relevant cross functional teams and owners - sales, QFO, UHN, finance, operations, HCE, marketing, and Optum.
• Identify and prioritize market barriers both internally and externally to enable teams to be more productive. Ability to work quickly and independently to ensure quality, coding and utilization stays on trend.
• Interact and represent UHC for all levels of external partner relationships, maintain constant communication with CEO's, CMO's and CFO's to drive performance.
• Drive strategic decision making that ultimately delivers on revenue, margin, growth, and retention.
• Support and develop internal team focusing on employee engagement, development, and retention.

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:

• 7+ years of healthcare/health plan experience
• 5+ years of experience working with hospitals and physicians
• Demonstrated success building relationships with external executives and stakeholders
• Demonstrated solid financial acumen and analytical skills
• Demonstrated excellent communication skills - ability to speak to large groups and television interviews as well
• Proven solid written and verbal communication skills, including well-developed interpersonal skills used to influence the behavior of others across a highly matrixed organization
• Proven track record of meeting business goals via driving disciplined, fact-based decisions and executing with discipline and urgency
• Proven organizational skills with ability to be flexible and work with ambiguity
• Proven ability to present complex information to C-Suite Leadership
• Proven ability to lead all market strategies of relevant cross-functional teams and owners
• Proven ability to interact and represent UHC for all levels of external partner relationships, maintain constant communication with CEO's, CMO's and CFO's to drive performance

Preferred Qualifications:

• Experience in a Medicare Advantage or other government-funded healthcare business
• In-depth experience with health care providers/ networks, HEDIS measures, Part D and clinical quality
• Basic knowledge of STARs, CAHPS, HOS, RAF
• Working knowledge of Medicare and/or Medicare Advantage

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $159,300 to $273,200 annually based on full-time employment. We comply with all minimum wage laws as applicable.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment