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Caring. Connecting. Growing together. The Chief Operating Officer, Community Plan of Kansas (UHC Community & State) will manage the operations of the health plan for our Medicaid managed care business. This role is on the executive leadership team and play a critical role contributing to the strategic direction of the health plan as well as developing talent within the organization. This role has overall accountability to meet the KanCare State reporting requirements, ensure operational compliance, support clinical operational objectives, oversee quality performance, maintain an influential, positive, and collaborative relationship with the state, direct and effectively develop operational goals into specific plans of action, and create a successful, collaborative team of people to achieve these goals.
This role is critical to serving as the 'account manager' for the Kansas Medicaid state relationship, driving overall performance, leading operational planning and managing a state-based operation through a matrix team. Working closely with the Kansas health plan and shared services operations teams, the Health Plan COO will become familiar with the established vision, mission and strategies of the organization and will build on these to effectively define, articulate and address the current and future needs and priorities of the local market. They will need to effectively lead a team to execute on requirements and transformative operations work that is focused on making a difference for our members and our state partners.
If you are located in Kansas, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities: - Develop/Lead/Execute Market-Specific Health Plan Operations
- Develop and monitor process maps, workflows, operating procedures, key operational metrics that enable consistently high performance
- Direct the operations of the health plan in providing innovative and cost-effective ways to comply with State contracts
- Develop and execute a forward-looking multi-year operational strategy
- Ensure commitment/support for health plan operations and programs from internal and external stakeholders
- Build commitment and support of matrix partners on the execution of shared business/enterprise goals
- Senior member of the leadership team in providing operational direction and decision-making for RFP bid processes as required, to drive business growth
- Lead project management activities that will successfully implement state requirements, RFP commitments, and expand health plan capabilities, in a timely, compliant, and impactful way
- Drive Health Plan Efficiency, Quality and Financial Performance
- Utilize stakeholder input to help shape and implement continuous improvement in operational quality and financial performance
- Ensure internal partners and/or external vendors adhere to business and contractual agreements
- Ensure that business continuity/emergency response plans are reviewed and tested regularly, up-to-date, and can be readily executed
- Utilize relevant systems and tools to identify and/or test opportunities for efficiency improvements
- Demonstrate understanding of the meaning and implications of key operational indicators
- Analyze health plan performance on relevant criteria
- Collaborate with functional partners (e.g., clinicians, healthcare economics, claims payment, external vendors, provider network, call center organization) to develop, implement, and/or drive health care quality and affordability initiatives
- Collaborate with relevant internal partners (e.g., Claims, Call Center, Information Technology) to successfully deliver on contractual requirements and capabilities that align with RFP commitments, business strategy, and operational efficiencies
- Ensure regularly scheduled and impactful Joint Operating Committee JOC reviews with participation from applicable business partners (e.g., Underwriting, Network, IT and Specialty Products, Operations, Regulatory, Product, and Marketing)
- Review and assign projects/initiatives based on resource capacity, capability, and expertise
- Conduct deep-dive reviews with relevant internal and/or external stakeholders to identify opportunities for continuous improvement
- Build, Maintain and Manage Relationships with Internal and External Stakeholders
- Build solid relationships with the State that drives the organization to deliver industry-leading customer service and satisfaction, establishing the health plan as a reference account with the state
- Build, develop, improve, influence and expand relationships with business leaders across UnitedHealth Group to ensure positive outcomes in the local market
- Represent the goals of the market to internal constituents across all lines of business to achieve solutions in the interests of the enterprise
- Influence state and community partners on company capabilities, tools, and processes that can be leveraged to improve delivery service and quality
- Drive Industry Leading Consumer, Customer and Provider Satisfaction
- Model a continuous focus on maximizing the member, customer and provider experience
- Drive the organization to deliver value beyond customer expectations
- Gather and analyze feedback from customers to identify new/emerging needs and new opportunities to offer a seamless customer experience and make appropriate changes to Health Plan strategies and programs
- Drive best in class operational and clinical performance for critical processes such as, contractual, compliance and regulatory, grievance and appeals, utilization management, call and claim and enrollment
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: - 8+ years of professional experience in Medicaid
- 8+ years as an operational leader
- 8+ years of related managed care experience
- 5+ years of people management experience
- Experience related to publicly funded government health care programs (e.g., Medicaid, Medicare or state health care programs for the uninsured)
- Operations experience in Medicaid, Medicare, or government health care program
- Demonstrated experience advising IT resources related to enterprise platform initiatives and provide direction on platform migration
- Demonstrated experience communicating clearly with internal partners and external regulatory agencies to represent UnitedHealthcare's interests
- Demonstrated technical and financial understanding of health care operations
- Demonstrated solid leadership and business planning skills within a matrix environment
- Demonstrated ability to anticipate and push change through the organization, equipping staff to adapt
- Ability to travel locally up to 10% of the time
- Reside in Kansas, or willing to relocate
Preferred Qualification: - Experience with managed care tactics such as value based contracting and quality performance programs
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
The salary range for this role is $150,200 to $288,500 annually based on full-time employment. 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: 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.
