Director, Payment Integrity

3 weeks ago

Eden Prairie, Minnesota, United States Optum Full time

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.

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

High Level Overview of the Role:

The Director of Home & Community Payment Integrity (H&C PI) will serve as the primary business owner coordinating with Finance, Product, Medical Directors and Healthcare Economics. The H&C PI Director will work closely with UHC, Optum Insight and the national affordability team. The focus is on ideation and implementation of incremental opportunities. The position will be responsible for deploying a PI operating model which will encompass the following activities:

  • Building operational dashboard reporting
  • Generating and maintaining pipeline of new ideas
  • Creating business case to influence PI partners to prioritize and deploy new edits, vendors and programs
  • Producing savings reporting aligned with HCE approved methodologies
  • Responsible for reporting performance to various stakeholders including H&C leadership and Affordability team
  • Holding PI vendors accountable for product performance

Day to Day Responsibilities:

  • Provide PI leadership encompassing all H&C PI services
  • Provide market-facing support
  • Lead program implementations for all Home & Community PI services
  • Ongoing program management for all Home & Community PI services
  • Work across H&C business including local markets, medical directors, product owners, HCE and finance
  • Lead the savings reporting and forecasting across all PI programs
  • Provide vendor management and partnership with internal and external entities to ensure that the appropriate operational processes are in place and proper follow up/communications are occurring
  • Drive favorable algorithm outcomes by partnering with matrix partners to provide policy expertise which will drive market savings and medical expense reduction
  • Effectively plan staff responsibilities and manage vendor deliverables to meet department goals
  • Lead and collaborate with UHC PI, Optum Insight PI and H&C stakeholders
  • Ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance
  • Ensure all operational metrics are met

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 leadership experience
  • 8+ years experience working within a health plan and/or managed care business operations
  • 5+ years in leadership role with experience in management of front-line staff
  • 5+ years of experience in forecasting and budget management
  • 5+ years developing and managing operational metrics
  • 2+ years of PI ideation, pipeline and CBA experience
  • 2+ years vendor management experience
  • Experience coordinating and navigating complex matrixed organizations

Preferred Qualifications:

  • Certified Coder in ICD 10 and ICD 9 or RN/LPN
  • Lean Six Sigma (Green belt/Kaizen)
  • Experience in fraud detection, analytic methodologies, payment policies and provider contracts
  • Claims processing expertise
  • Optum Care / Optum Health expertise

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, Washington, Washington, D.C. Residents Only: The salary range for this role is $122,100 to $234,700 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.

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.

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.

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