Capability Director – CMS – Remote

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

 

The successful candidate will have demonstrated experience in leadership, strategic planning, operations, and management of both direct and matrixed functions. This individual will partner closely with leaders at UHC C&S, M&R, and Optum entities to drive high-caliber and consistent quality outcomes, member and customer satisfaction, and growth for our complex populations. You must be someone who can navigate through ambiguity to create clarity, set a vision and then gain organizational buy-in, lead by influence across functions, and have unrelenting passion to make a difference in health care.

 

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

 

Primary Responsibilities:

• Develop national pharmacy strategies, create innovative programs, oversee program implementations, monitor performance using key performance indicators (KPIs), and provide ongoing support to grow C&S Medicaid and DSNP businesses
• Evaluate product/program performance to inform and refine organizational goals and objectives. This involves analytical, experimental, investigative, and other fact-finding activities aimed at differentiating the pharmacy portfolio and solutions to improve value, competitive position, and regulatory requirements
• Gather and classify new product ideas, capture specifications for product requirements and functionality and, when appropriate, recommend changes to current product development procedures based on market research and new trends
• Collect and analyze internal and external data to identify key features, characteristics, emerging needs, business and legislative trends to inform program/solution roadmaps
• Create and build robust analytical and financial models with big data, including claims data, clinical data, and national data sources (e.g. CMS, AHRQ, Medicaid, etc.) to accelerate program design, feasibility studies, and return on investment opportunities
• Leader over leaders with direct reports in pharmacy support roles within healthplans in Medicaid space
• Size product and program opportunities, investment and/or cost impact, assess and present business cases and timelines to advance go-to-market strategies
• Identify best partners/vendors for implementation and execution of the solution and negotiates excellent terms of the business relationship and contract, as well as all critical business requirements, service level agreements, performance guarantees and future state governance
• Work with selected partners to fully charter new/enhanced program implementation plans including ISAs/ contracts, detailed objectives (KPIs), key milestone dates, scope, roles and responsibilities, and performance guarantees
• Manage program implementation(s) directly to quickly mitigate obstacles, escalate issues, resolve/clear barriers, and foster prompt decisions
• Keeps stakeholders well-apprised of positive and negative changes in project plan and/or glidepath, and provides regular status updates
• Leverages insights from stakeholders, benchmarking and other sources to continually improve program/solution ROI and other quantitative value
• Collaborate with shared services partners and support oversight of shared functions that are both directly and indirectly responsible for quality, operational effectiveness, growth, retention, and total cost of care
• Create & deploy strong process and project mgmt. disciplines, including SharePoints, website(s), data repository, etc. to enable clear, repeatable, and scalable solutions, delegation oversight of partners/vendors
• Collaborate with matrix partners across businesses and functional groups to translate (e.g. CMS, States) required capabilities into concrete operational processes, technical requirements, and KPI/measurements by applying advance project mgmt. disciplines (initiation, planning, execution, and performance monitoring) to ensure implementations are executed on time
• The Capability Director must possess a solid knowledge of all lines of business, product and cohorts within Managed Medicaid. This includes TANF, ABD, Complex Care or LTSS, CHIP and DUAL Medicare programs, as well as members with Developmental Disabilities

 

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:

• 5+ years health plan or pharmacy benefit manager experience with knowledge & focus in Medicaid and/or Medicare (TANF, ABD, Complex Care or LTSS, CHIP and DUAL Medicare programs, as well as members with Developmental Disabilities)
• 3+ years of leadership experience (SME, team lead, coaching and mentoring), in managing teams, collaborating with business partners across matrixes, and vendor management
• Proficiency with Excel, Tableau, PowerBI, and Visio, PowerPoint, SharePoint, SmartSheet
• Expert at strategic conceptualization both at a local level and within the framework of being a part of a national organization
• Proven ability to identify and leverage use cases to inform and design solution(s), feature roadmaps, and execution plans 
• Demonstrated success in delivering products and value within an agile-development framework
• Ability to interact cross functionally within the organization, assess various viewpoints and arrive at a solution that best meets organizational needs

 

Preferred Qualifications:

• 5+ years of SAS or SQL coding experience extracting, manipulating, and analyzing large datasets and models using pharmacy data, medical and encounter data, and financials, including external sources
• Experienced with Community and State Pharmacy Portfolios and DSNP
• Highly skilled at engaging and presenting to large groups, including senior level management
• Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others
• Highly motivated and self-directed with the ability to motivate and inspire teams
• Excellent attention to details, time management, organizational, and prioritization skills and ability to balance multiple priorities
• Critical thinking and problem-solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action

 

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

 

The salary range for this role is $124,500 to $239,400 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.

 

 

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

 

UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.