Senior Product Manager, M&R Product Operations and Benefit Administration – 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

Value Based Care (VBC) is a strategic directive for Medicare Advantage plans, including Special Needs plans, across the enterprise. 

This position within the MA Product Operations and Benefit Administration team will lead, execute, and provide subject matter expertise for VBC growth expansion in new and existing markets, focusing on the NICE to COSMOS migration and COSMOS/CSP platforms. The role involves cross-functional collaboration with various disciplines and delegate partners to ensure a comprehensive understanding of Medicare Advantage products and benefits. 

As a Senior Product Manager for M&R Product Operations and Benefit Administration, we depend on your influence, decision-making, and communication skills with business partners and leadership. You will manage and deliver a strategic framework for value-based reimbursement implementation and readiness initiatives between UHC, Optumcare, and other external delegates for UnitedHealthcare’s Medicare Advantage plans. You will function as a subject matter expert in the area of MA Product Individual operational tasks, sequencing and delivery of capitation, delegation, and other risk-based contracting for CA. Your critical thinking skills will be necessary to ensure all parties fully understand end-to-end tactical implementation requirements and outcomes. 

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

Primary Responsibilities:

• Lead and manage migration, implementation, and steady state activities:
  • Represent MA Product Individual in migration, implementation, annual readiness, and steady state key partnership meetings and projects for California and CSP Facets
  • Schedule and run program meetings, attend cross-functional meetings
  • Facilitate and manage mid to large size workgroups (~50-100), fostering collaboration, trust, and disciplined accomplishment of tasks and target dates
  • Develop and execute on project plans that define key tasks and milestones, incorporating feedback from SMEs and stakeholders
  • Organize and lead teams including but limited to Case Installation, Provider Network, Claims, Clinical, Member/Provider Services, Portal Teams, and Ancillary, and Value Based teams that implement and maintain value-based risk arrangements for M&R for COSMOS 
  • Ensure alignment and understanding of program/project scope and objectives with the organization’s strategic objectives, in consultation with applicable stakeholders
  • Support year-over-year growth, expansions, service area and plan changes for California and other growth and expansion markets that are not currently delegated 
• Take Lead and Guide Support and Configuration:
  • Manage and support end-to-end setup, configuration, systems, applications, and processes to support more than 200 delegate locations in the California market
  • Collaborate with cross-functional teams to configure delegated membership, DOFRs, and core structures in UHC platforms (COSMOS, CSP Facets, USP, GPS, MAPS, etc.) and delegate claims platforms
  • Identify delegates by CMS contract, document, and confirm configuration details for all HPBPs and Group numbers
  • Assist in developing business rules and auditing for annual member product/plan alignment support for auditing of UCard for all markets
  • Collect and input delegate-level data and requirements by HPBP and group numbers into applications like MAPS and COSMOS. This supports UCards, reporting, enrollment, eligibility and benefits, claims, provider and member services, appeals, clinical programs, and various operational teams
  • Ensure delegate information is 100% accurate in all sources of truth tools and resources, including Delegation Snapshot, provider directory, Maestro, Spire, ICUE, NDB, and other systems and applications
  • Maintain a comprehensive understanding of capitation, including its mechanisms and various risk levels, as well as the language in capitation agreements for each delegate and respective
  • Division of Financial Responsibility (DOFR) contracts. Possess in-depth knowledge of services listed in the DOFR. Collaborate with business and operational teams to ensure USP configuration aligns with the DOFR. Stay updated on changes to USP, DOFR for each delegate, and submit service code changes to ensure all processes and applications remain aligned
  • Guide teams across multiple disciplines as they complete implementation tasks including provider setup, benefits, ID cards, claims, portals, member services, provider services, enrollment, encounters, mis-directed claims process or other
  • Assist in developing business rules to support annual and serve as a support UCard audits in California as needed
  • Contribute to business documentation and provide test scenarios to assist with grooming of capabilities for IT projects. Elicit, understand, and articulate customer needs to downstream business partners 
  • Manage mid-year adds/changes and submit COSMOS service changes for USP configuration
  • Protect the member and provider experience, applying insight and analysis and implementation tasks to make sure delegation implementation activities support senior leadership direction and ensure positive net promoter scores and overall delegate experience for both members and providers
• Oversight and Education:
  • Provide comprehensive oversight and education to California delegates, ensuring consistent administration of benefits in accordance with UHC standards and CMS filed/approved bids
  • Schedule and run effective meetings, create and update internal and external materials
  • Train health plan, internal teams, and delegates on benefit administration
  • Identify gaps in benefits administration and partner with the Delegation Oversight Team, Market Managers, and Encounter team to resolve these gaps. Develop and execute process improvement strategies. Leverage lessons learned from other delegates and share these insights with California delegates
  • Build solid relationships with California delegates to ensure they know who to contact for benefit related questions 
• Communications and Materials:
  • Create content for MA Product, cross-functional teams, and delegates
  • Facilitate readiness meetings, develop materials, and market communications
• Issue Resolution:
  • Probe and document issues, facilitate calls outside formal workgroups to resolve open items, and escalate critical issues quickly when needed
  • Participate as Product SME in war room resolution meetings, as needed
  • Complete and contribute to status and stakeholder reports or dashboards
• Cross-Functional Collaboration:
  • Work with various business segments (Benefit Configuration, Contract Installation, Enrollment, Health Plan, Market Managers, Capitation Configuration & Technical Support Provider Network,
  • Claims, Clinical, Member/Provider Services, Portal Teams) to support delegation implementation and readiness activities
• These responsibilities ensure effective management and delivery of strategic initiatives, supporting the growth and maintenance of delegated plans and ensuring alignment with organizational goals

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 of Healthcare Insurance experience 
• 5+ years of demonstrated ability of working with urgency in managing projects or time sensitive commitments
• 5+ years of managing large-scale programs, tasks and priorities involving cross-functional, cross-enterprise teams. 
• 5+ years of demonstrated ability to interface and present to senior management effectively.
• 5+ years of experience driving results and operational excellence improvement 
• 5+ years of proven organizational skills with ability to be flexible and work with ambiguity
• 5+ years of working autonomously to drive projects forward 
• 5+ years of advanced Excel experience (Pivot Tables, VLOOKUP, and data manipulation)

Preferred Qualifications:

• Experience with developing creative materials and presentations to large groups and senior leadership with ability to present verbally and in writing
• Experience or familiarity with M&R systems such as GPS, MAPS, COSMOS, CSP, NDB 
• Medicare experience
• Proven excellent communication skills, both written and verbal
• Proven solid problem-solving skills and attention to detail
• Proven product management and/or program management 

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

The salary range for this role is $106,800 to $194,200 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.