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The SVP of Government Programs Clinical Operations has responsibility for developing and executing the clinical strategy and affordability plans for Community & State and Medicare & Retirement. The role is accountable for managing a $2B+ clinical budget. This includes owning program investment, reduction and redesign decisions that have enterprise impact. This leader is responsible for an annual affordability target of ~$1B and accountable to be certain regulatory clinical requirements are met. There will be strategic oversight of program design, training, IT development, accreditation, compliance oversight and workforce management for over 4,000 clinical FTEs. The role will be the clinical executive owner for M&A due diligence and RFP responses for both lines of business. The SVP of Clinical Operations for Government Programs has cross-functional accountability / partnership with Enterprise Clinical Services (Behavioral, Population Health, Post Acute, HouseCalls etc.), IT (Hotspotting, Nerve Center, etc.) and UCS (UM Modernization, InterQual Transition, ACOs, etc.). This role has a significant role in distinguishing our Medicare and Medicaid businesses in the marketplace by transforming the delivery system, supporting sustainable care and fueling differentiated growth.
Results are critical to this leader's success, as is a personal alignment with UHC's mission to help people live healthier lives and the core belief that an organization can manage cost and deliver quality and value to its customers. In total, C&S and M&R employ over thirteen-thousand employees and serve over eighteen-million members across all 50 states and the District of Columbia.
The SVP will be a member of the Community & State and Medicare & Retirement Executive Leadership Teams and will interface with executive leaders within the organization to provide direction and decision making. Leaders that will report through the SVP include the Affordability and Cost Management VP, Medicaid Care Model VP, the Medicare Care Model and Strategic Planning Senior Directors. The role is accountable directly to the CEOs of Community & State and Medicare & Retirement.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Business & Strategic Planning
- Lead the development of the annual business plan and 3-year strategic plan for the Government Programs clinical operations team
- Provide insight into key trends and market needs, make key strategic decisions and drive organizational alignment
- Translate strategic plans into organizational goals and execution tactics
- Prioritize investments and assist in securing funding (e.g., ROI, potential risks, financials)
Market Analysis & Competitive Positioning
- Oversee and set direction for data analysis designed to guide strategies and be more intelligent about how we approach the market
- Synthesize and interpret applicable data from internal and external sources to identify market characteristics/ needs/problems (e.g., market opportunities, financials, technology trends, user preferences, industry/regulatory/legal standards)
- Provide strategic direction to executive leadership team regarding the competitive landscape of clinical program and payment reform trends (e.g., strengths, weaknesses, gaps, product portfolios, win/loss analysis)
- Define and build the core competencies/capabilities that distinguish us in the Medicare and Medicaid marketplace (e.g., key differentiators)
End-to-End Capability Integration
- Define Medicare and Medicaid strategies for a fully integrated care model, including creation of a seamless clinical member and provider experience
- Accountable for driving end-to-end integration across member and provider touch points to create a single, holistic clinical model
- Business leader responsible for cross-functional and enterprise-wide alignment of medical and behavioral for the clinical services, network and operations
- Owns output of the entire system made up of all related end-to-end clinical and quality processes
- Understanding of clinical program development and innovation; this person will be responsible for developing new clinical programs such as maternity, OUD, etc.
Business Development & Growth
- Develops value propositions for applicable audiences to drive planning and implementation (e.g., states, members, providers)
- Represents the business to key external stakeholders and clients, including state regulators and strategic business partners
- Influences organizational direction and strategy on care delivery and affordability and innovation
- Ensures program strategies address applicable market expectations and needs
- Provides assessment of portfolio performance against expectations and facilitates or influences changes to assigned populations to improve competitive position and optimal product performance
- Communicates LOB status and roadmap evolution executive management
- Evaluates program performance against expectations and facilitates or influences changes to programs
- Manages program portfolio to improve competitive position and optimal performance
- Responsible for the design, development, management or sun-setting of new or existing programs
Clinical Performance & Affordability
- Provides leadership to and is accountable for the performance (financial, operational, regulatory) and results of diverse or broad functions
- Evaluates program outcomes, quality, affordability, and operational results with shared set of metrics and hold shared services team accountable
- Identify causes of performance deficiencies and determine appropriate follow up actions
- Interprets financial reports, identify reasons for financial performance gaps, and identify opportunities for improved financial performance and enhanced return on investment
- Leads and drives large scale initiatives, assists with program governance and manages interdependencies, estimates and allocates resources
- Develops, translates and executes strategies or functional/operational objectives at the segment level
- Executes against strategic, tactical, and operational goals in partnership with market, regional and national leadership
- Navigates and influences multiple cross-functional teams in a complex, matrix work environment
- Partners with key operations and support teams and leaders to define program requirements and expected benefits; ensures associated service level agreements are met
- Develops and maintains policies and procedures in support of quality, growth, and baseline execution
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.
- Bachelor's degree
- Executive leader with a minimum of 15 years of demonstrated progressive career accomplishments
- 10+ years health industry experience
- 10+ years of experience in senior leadership roles
- Expert at strategic conceptualization both at a local level and within the framework of being a part of a national organization
- Accurately scopes out projects, sets objectives and goals, develops schedules and resource assignments, measures performance against goals, and evaluates results
- Strong demonstrated ability to lead business initiatives to a successful outcome
- Strong communicator; capable of effectively presenting ideas and selling concepts and tactics; excellent writer, proven ability to communicate effectively with executives; ability to quickly understand needs and act on those needs; ability to conceptualize and effectuate change management and "out-of-the-box" thinking
- Proven cross-functional influence and well-developed relationship building skills, willing to take a leadership role driving initiatives, working across organizations and structuring approaches to new opportunities
- Ability to effectively deal with ambiguity - can effectively cope with change, can shift gears comfortably, can decide and act without having the total picture, comfortably handles risk and uncertainty in a manner consistent with UnitedHealth Group’s core values
- Demonstrated leadership and hands-on experience, strong leader and motivator with the ability to mentor talent within the organization; able to provide work direction; able to attract and retain top talent
- If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders
- Advanced degree
- Clinical program design, population health and/or management of large scale clinical operations
- Understanding of Medicaid and Medicare populations, state programs and government businesses
- Good negotiation, problem solving, planning and decision-making skills
- UnitedHealth Group experience preferred
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)
Colorado Residents Only: The salary range for Colorado residents $300,000 is to $350,000. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.
*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.
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