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UnitedHealth Group Associate Director of Medical Management, TRICARE - Telecommute in Eden Prairie, Minnesota

At Optum, the mission is clear: Help people live heathier lives and help make the health system work better for everyone. OptumServe provides health care services and proven expertise to help federal government agencies modernize the U.S. health system and improve the health and well - being of Americans. By joining OptumServe you are part of the family of companies that make UnitedHealth Group a leader across most major segments in the U.S. health care system. OptumServe offers customizable solutions to serve the diverse needs of commercial customers, as well as federal and state agencies, including the U.S. Departments of Defense, Veterans Affairs, and Health and Human Services.

There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Ready for a new path? Start doing your life's best work (sm).

The Associate Director, TRICARE Medical Management (UM) is responsible for ensuring that UM requirements are identified, addressed, planned and solutioned for and incorporated into work processes and data reporting to meet UM requirements for the TRICARE Request for Proposal (RFP) Statement of Work (SOW). This includes leading development of the UM delivery model and UM Plan. The Associate Director for UM is responsible for development, incorporation of UM requirements and solution into the integrated Medical Management (MM) Program and Project Plan contributing to the OptumServe RFP for the TRICARE contract. The Associate Director for UM collaborates with the TRICARE Medical Management team members and cross functional teams and partners with enterprise or external business partners to develop the UM model, work processes and services delivery. Upon contract award, the Associate Director oversees transition and implementation of the UM Program in accordance with the TRICARE Managed Care Support contract.

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

Primary Responsibilities:

  • Develop, document, and plan for delivery of a UM Program supporting an integrated model of MM delivery to meet TRICARE RFP requirements for the MM Program

  • Establish UM team organizational structure, work assignment and work cadence to meet timelines for interim and final deliverables to Program Management for inclusion in the MM Solution for the OptumServe proposal for the TRICARE RFP

  • Provide UM subject matter expertise for the MM program, communicating needs, requirements, and recommendations for development of the UM program to cross workstream teams, Program Management and organizational leaders, particularly for integration of adjunct technology and external components of the care management platform to build a customized MM system

  • Work closely with the MM Program Clinical Consultant and Director, MM to develop and execute the MM Program project management plan

  • Use available data and data analysis and accurate assumptions for the UM component of the TRICARE Medical Management Program Direct cost BOE

  • Continuously re-evaluate RFP requirements and work process development. Articulate and seek support for additional needs to develop/execute the UM Program plan and delivery

  • Identify data reporting requirements, develop comprehensive list of UM Reports and provide to Program Management Reporting work team

  • Ensure incorporation of NCQA Standards for UM into technology solution and work process development, enabling achievement of NCQA accreditation

  • Work effectively with selected sub contracted vendor(s) to incorporate work processes, system integration and establish plans/agreements for execution of contracted work

  • Oversee development of staffing plans, recruiting, hiring, onboarding and training of UM staff for implementation upon award of contract

  • Oversee trending, monitoring, and reporting of program performance metrics (contractual and internal), survey monitoring, auditing, CAPAs, and program performance improvement for UM operations upon award of contract.

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:

  • Active, unrestricted Registered Nurse (RN) or Nurse Practitioner (NP) license

  • 7+ years’ experience working in in UM Programs including areas of pre-authorization, clinical case review, appeals, referral to case/disease management programs and assignment for transition of care coordination

  • 4+ years progressive supervisory/leadership experience in UM Programs in a healthcare system

  • Experience in developing UM programs, including authorization processes, workflows, staffing and business requirements.

  • Operational knowledge/experience of performance measurement tools and quality management continual process improvement.

  • Statistical, analytical and independent problem-solving skills related to project/UM program development planning and implementation.

  • Proficiency with multiple Computer applications (i.e., Microsoft Office- Word, Excel, PowerPoint, Visio desired).

  • United States Citizenship.

  • Ability to obtain favorable adjudication following submission of Department of Defense form SF86 NAC form SF86.

  • 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

Preferred Qualifications:

  • Master’s degree in Nursing or Healthcare Administration (or other related advanced degree)

  • Certified Case Manager (CCM)

  • Knowledge of NCQA accreditation standards for UM programs

  • Experience with TRICARE Managed Care Support Contracts/Military Health System

  • Ability to understand and synthesize TRICARE Managed Care Support contractual requirements and associated TRICARE manuals to develop business requirements and solution development

  • Effective interpersonal skills and ability interact effectively with various workstream groups, sub contracted vendors, and customers.

  • Ability to express ideas clearly and effectively verbally and in writing; use appropriate organization, structure and grammar in written communication.

  • Experience in preparing and confidently delivering reports and presentations to multiple levels of leadership.

  • Solid statistical, analytical and independent problem-solving skills at a program level

  • Ability to educate, motivate, and/or influence others to understand clinical processes

  • Experience managing a remote team

Optum, a part of the UnitedHealth Group family of businesses, continues to evolve and make a bigger impact through its extensive expertise in combining technology, data and people to create novel health care solutions and services across the globe. OptumServe is following suit by creating and delivering care that meets the health needs of active duty service members, veterans and their families. We're partnering with federal and state government agencies to meet the readiness and health needs of active duty military members and veterans by providing preventive health screenings and assessments to ensure that troops are ready to answer the call of duty. For those who want to intensify their impact in a career that brings together challenge, learning and growth, OptumServe is the right place to do your life's best work. (sm)

Colorado Residents Only: The salary range for Colorado residents is $94,500 to $171,700. 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.

Job Keywords: RN, registered nurse, NP, Nurse Practitioner, case management, medical management, quality management, utilization management, program management, implementation, TRICARE, military, telecommute