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Sr. Dir. DSNIP – STARS / Ops. C & S
Category: Health Care Industry , Insurance
  • Your pay will be discussed at your interview

Job code: lhw-e0-89829550

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UnitedHealth Group

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  Job posted:   Fri May 18, 2018
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Sr. Dir. DSNIP – STARS / Ops. C & S
The Community & State (C&S) Vice President (VP) of Dual Special Needs Plans (DSNP) Stars Operations has national accountability for Stars performance improvement across C&S Dual Special Needs Plans.
In close collaboration with Medicare & Retirement (M&R) and C&S leaders, the DSNP Operations leader will develop and lead the implementation of a C&S DSNP Stars performance improvement strategy.
This includes responsibility for working with functional teams and local health plans to ensure that the initiatives developed by M&R and Untied Clinical Services (UCS) consider the unique characteristics of the DSNP population of each market. Community & State currently serves over five hundred thousand DSNP members.
This leader will have shared accountability with local health plans and national DSNP/Stars shared service partners to drive to 80+% of DSNP membership in 4+ Star plans.
This requires a deep understanding of Medicaid, Medicare, HEDIS/Stars, operations, analytics and process improvement.
The VP of DSNP Stars Operations must understand how to drive complex business processes throughout and across a matrix organization, and will be accountable to quality performance targets and contractual business requirements.
This person must work to ensure compliance with state and federal requirements and performance against standardized metrics, including accreditation, Healthcare Effectiveness Data and Information Set (HEDIS), Consumer Assessment of Healthcare Providers and Systems (CAHPS) and other Stars measures.
The ability to lead through engaging, motivating, and influencing teams without direct hierarchal oversight is imperative.
The selected leader will report to the VP of UnitedHealthcare (UHC) C&S Quality Strategy.
The position works closely with members of the C&S Executive Leadership, Regulatory and Compliance, Marketing, Clinical Services, Optum, C&S Operations, and other UHG departments accountable for quality.
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.
C&S is the largest health benefits company dedicated to the economically disadvantaged, medically underserved and those without employer-funded health care coverage, serving members in 26 states and the District of Columbia. Primary Responsibilities: National oversight of the C&S DSNP Quality budget, including ensuring visibility of budget items and charge backs to local market leaders. Collaborate with local and national team(s) across C&S and M&R to develop overarching DSNP Star strategy.
Monitor and assist with the facilitation of national, regional and local efforts aimed at improving Star results. Identify market specific priorities and determine the appropriate strategic approach to drive Stars improvement.
Provide thought leadership and recommendations for new programs. Lead and oversee the development of innovative and scalable approach to achieving Five Stars. In collaboration with a cross functional team (clinical, IT, BI, Operations, Compliance, National CAHPS, National HRA leaders, etc.) review existing tools to support and monitor DSNP performance, identify enhancements, plan and develop a robust system to provide needed meaningful visibility into performance status Responsible for monitoring the effectiveness of initiatives deployed, ensuring that functional areas deliver on the agreed upon targets for each contract and creating visibility into issues. HEDIS Process and Performance Improvement. Develop C&S DSNP strategy for HEDIS 2019 and beyond to achieve improved star performance and decrease HEDIS project spend.
Develop "Voice of the Provider" for C&S DSNP in effort to improve provider satisfaction and provider domain of CAHPS.
Provide assessment of portfolio performance against expectations and facilitate or influence changes to programs to improve quality outcomes and optimal performance. Build and maintain relationships to drive accountability and reach goals with leadership across C&S and the enterprise, including M&R Executive Leadership, Regional and Health Plan Leadership, Regulatory and Compliance, Operations, Clinical Services, Optum and key external stakeholders. Collaborate with Market and Regional CEOs and their cross-functional leadership teams to identify specific market and population needs and creates structured process to incorporate market variances into core model. Execute against strategic, tactical, and operational goals in partnership with market and regional leadership and cross-functional partners.
Navigate and influence multiple cross-functional teams in a complex, matrix work environment. Required Qualifications: Bachelor's Degree Required, MD or DO preferred 8+ years health care industry experience 8+ years of experience in leadership role 5+ years of experience with quality improvement processes and accreditation, including clinical performance measurement 5+ years of experience with HEDIS/Stars Medicaid and Medicare business knowledge, UnitedHealth Group experience preferred Ability to develop and deliver a business plan that can effectively organize, plan, direct, manage, and maintain profitable products throughout their life cycle Expert at strategic conceptualization both at a local level and also within the framework of being a part of a national organization Good negotiation, problem solving, planning and decision-making skills 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 result Strong communicator; capable of effectively presenting ideas and selling concepts and tactics; excellent writer, proven ability to communicate effectively with executive-levels; ability to quickly understand needs and act on those needs; ability to conceptualize and effectuate change management and "out-of-the-box" thinking Proven ability to build relationships cross-functionally and lead toward common goals Ability to effectively deal with moderate levels of ambiguity - can effectively cope with change, can shift gears comfortably, can decide and act without having the total picture, comfortably handles risk and uncertainty Proven ability to take initiative to meet the challenges within the environment, oriented toward solutions through collaboration, able to motivate and lead experienced healthcare professionals, and ability to lead complex projects and optimize the output of teams 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 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) 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. Job Keywords: healthcare, leadership, quality improvement, community and state, HEDIS, Stars 761dd773-ce5c-4689-825e-f2e6cffb79df
*Sr. Dir. DSNIP - STARS / Ops. C & S*
*Minnesota-Eden Prairie*

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