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 and start doing your life's best work.(sm)

The Director, Clinical Performance and Evaluation on the Individual and Family Plan (Individual Exchange) team will lead the evaluation and measurement of clinical performance with an emphasis on key strategic priorities including Virtual First benefit designs and clinical model improvement opportunities. This individual will also be a key leader in partnering with internal and external clinical vendors to measure and improve clinical performance, while ensuring alignment with key stakeholders.

This individual will be responsible for evaluating clinical performance to inform key operational and strategic business decisions. This includes ideating, designing, planning, and executing on performance evaluation studies to identify opportunities for clinical model improvement. The Director, Clinical Performance and Evaluation will work closely with analytical teams including the Medical Economics, Healthcare Economics and Actuarial teams on thought leadership, study design, data acquisition and data analysis. This role requires solid analytical ability and experience working with a variety of healthcare data including medical claims, pharmacy claims, authorization data, referral data, and health outcomes data. Key areas of focus include Virtual First benefit plan design, specialist referral requirements, member utilization patterns, and member segmentation. This individual will also be a key collaborator with the Pharmacy team, engaging on key strategic analyses to inform decision making and alignment with the Individual and Family Plan Clinical team.

The Director, Clinical Performance and Evaluation will also oversee relationships with select key internal and external clinical vendor partners, with responsibility for improving clinical outcomes and ensuring optimal model design and execution in support of members. The scope of this oversight is broad and may encompass various functional areas including Marketing, Risk Adjustment, Coding, Member Experience, and Provider Data. In addition to responsibility for the day-to-day clinical relationship for select internal or external partners, this individual will be responsible for designing and executing on Clinical Quarterly Business Reviews with executive leadership to identify areas of opportunity, report on progress, and share clinical performance analysis including on topics listed above. This role requires excellent communication skills, a high degree of collaboration with matrixed partners, data synthetization and summarization, and the ability to operate independently and in situations of ambiguity.

The Director, Clinical Performance and Evaluation must be able to draw upon a matrixed team to drive complex business processes throughout the organization, as well as with external stakeholders. This role will report to the Vice President, Clinical Strategy and Affordability for the Individual and Family Plan within Community & State Growth.

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

Primary Responsibilities:

• Develop and execute performance evaluation studies to identify opportunities for clinical model improvement
• Analyze data to develop actionable insights in support of strategic priorities in partnership with Medical Economics, Healthcare Economics, Actuarial, and other key functional areas including Operations and Network
• Prepare and present presentations on a variety of topics including performance evaluation studies, clinical model improvement opportunities, and strategic insights
• Collaborate with numerous internal teams across functional areas while engaging key stakeholders
• Manage relationships with select internal and external clinical vendor partners
• Drive demonstrable results through oversight and management of select vendor partner relationships
• Lead and/or support Clinical Quarterly Business Reviews on a wide range of topics
  

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:

• Minimum of a bachelor’s degree/4-year degree or equivalent experience
• 5+ years of professional work experience in healthcare
• 2+ years of experience in management consulting, quantitative research, or academic/ governmental healthcare data research
• Experience with the Individual Exchange, Medicaid, or Commercial benefit plans
• Experience leveraging healthcare data to answer research or strategic questions
• Advanced skills in Microsoft Excel
  

Preferred Qualifications:

• Advanced degree (e.g., PhD, MBA, MPH or other related degree)
• 2+ years of managed care experience
• Highly motivated, organized individual with a willingness to learn
• Excellent communication, presentation and listening skills
• Exceptional relationship skills, with proven ability to quickly build and maintain solid relationships across diverse functions and leaders
• Ability to be adaptable and flexible in collaborating with key stakeholders while setting direction
• Proven ability to quickly gain credibility and influence in partnering with stakeholders
• Ability to successfully work in a matrix management environment, with a proven track record of building and maintaining effective internal partnerships
• Ability to work independently and be a self-starter in a dynamic, fast-paced environment
  

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 d o your life's best work.(sm)

Colorado, Connecticut, Nevada, or New York City Residents Only: The salary range for Colorado residents is $113,500 to $218,100. The salary range for Connecticut/Nevada/New York City residents is $113,500 to $218,100. 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 employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

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.




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.