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UnitedHealth Group Associate Director Clinical Quality - telecommute in Philadelphia, Pennsylvania

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

This individual has national accountability for overseeing the design and implementation of state Medicaid Behavioral Health quality programs as well as Commercial/Payer Behavioral Health Quality Programs. This leader will be accountable for the Quality/Population Health sections of Medicaid and Commercial RFPs, working with RFP architects, underwriters, and prospective customers to help optimize and develop programs and share best practices, and may also serve as the implementation lead in new markets until a local leader is hired. The Director must understand how to drive complex business processes throughout and across a matrix organization and must work to ensure compliance with state and federal requirements and performance against standardized metrics, including accreditation, Healthcare Effectiveness Data, and Information Set (HEDIS) and other Quality measures.

The position is not to take the place of the RFP writers but is to understand the overall quality program operations and manage the flow of information related to successful completion of a proposal and to retain a library of national programs and initiatives for future opportunities.

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

This position leads clinical quality RFP responses across all Optum lines of business nationally (Payer, Optum Direct, United Healthcare Community and State (C&S), Employer and Individual (E&I), and Medicare and Retirement (M&R)). This role has a direct impact and contribution to total revenue of Optum Behavioral Health as the result of successful submission of new business or competitive procurement through the RFP process. Successful BH proposals add membership per month in C&S, M&R and E&I, as well as additional member growth in payer segments. This role also has a direct impact on quality as this position is responsible for assuring that quality programs are correctly presented to potential customers and are implemented fully and according to contractual agreements.

In order to drive winning bids, the Clinical Quality RFP Lead must possess the following key elements which will prove successful in submission of comprehensive BH quality responses. These elements include:

  • Market competitive intelligence

  • Complete and accurate understanding of all clinical quality program offerings for all business nationally

  • Comprehensive responses that reflect the value of a robust clinical quality program

  • Use of innovative approaches to clinical quality challenges and ability to design innovative programs in collaboration with national leadership

  • Foresight and visibility to be able to operationally support the business upon award

  • Ability to help implement new business based on the RFP response

To ensure these critical elements are considered this individual must maintain responsibility for the following:

  • Ensuring content library for the clinical quality department is updated and current

  • Staffing for RFP-ensuring clinical quality staffing requirements are budgeted

  • Supporting market solution development as it relates to clinical quality

  • Comprehensive understanding of current clinical quality programs and potential risks and barriers to implementation

Additionally, this individual will serve as support for new business implementations through the following:

  • Assisting in hiring of new staff, as needed

  • Overseeing implementation project plan development and executive leadership updates on implementation progress, as well as the identification and escalation of implementation risks

This position supports RFP trending and forecasting and is responsible to conduct monthly RFP pipeline updates to detail RFP activity (Pre RFP, Active RFP, Win Loss and Hold) to the National Clinical Quality Leadership.

Position must also keep engaged and award of ongoing clinical quality innovations in order to support customized responses to RFP requests. This requires working closely with Innovation Teams and key leadership areas within the organization. Much of this culminates in the Pre-RFP Solutioning which entails, but is not limited to the following:

  • Gathering state specific intelligence (market/local/regional) to assess quality program needs

  • Attending meetings to brainstorm for innovative solutions that could be implemented in the market

  • Gathering information on key clinical quality solutions to be utilized in RFP content

  • Identifying key opportunities for strategic growth and improvement in clinical quality programming

The above applies to all lines of business, Payer, Community and State, Optum Direct, as well as E&I.

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:

  • 4-year degree, masters preferred

  • 3+ years in healthcare/managed care

  • 3+ years of experience in Quality Management/Quality Improvement

  • 2+ years of experience in proposal development/writing experience and business implementations or strategy development

  • Demonstrable C-Suite presentation skills

  • Sound project skills

  • Foundational knowledge of NCQA HEDIS measures and performance measures/clinical metrics

Preferred Qualifications:

  • Behavioral health experience

  • Medicaid experience

  • Knowledge in NCQA and/or URAC accreditation

UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity 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. 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.

*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: Director Behavioral Health Clinical Quality RFP Strategy Lead, Behavioral Health, BH, RFP, Healthcare/Managed Care, Quality Management, Quality Improvement, NCQA, Medicaid, Telecommute, Telecommuting, Telecommuter, Work From Home, Work At Home, Remote, Philadelphia, PA, Pennsylvania