Chief Operating Officer - Community and State - Rhode Island

Chief Operating Officer - Community and State - Rhode Island

03 Jul 2022
Rhode Island, Warwick, 02886 Warwick USA

Chief Operating Officer - Community and State - Rhode Island

UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm)The Chief Operating Officer is responsible for management of all business operations and ensuring contractual compliance for the Medicaid and Dual Special Needs Plan (DSNP/Medicare) lines of business. This role provides subject matter expertise in project management, project scope definition, risk identification, project methodology, resource allocation, stakeholder engagement and strategic direction.The COO is also responsible for the design, coordination, and completion of operational improvement projects across various functional areas within UnitedHealthcare. The COO will review the departments performance and effect change as needed to improve service, simplify the workflow, and assure compliance with regulatory requirements. They will effectively lead a team that is focused on making a difference for our members and our state partners.The COO is also responsible for management and administration of multiple functions and general Business Operations, to include Quality Management and Network Strategy functions. This position manages daily operations of multiple levels of staff and multiple functions/departments across UnitedHealthcare.Primary Responsibilities:Collaborates with CEO and Executive Team on strategy and business planning to achieve business goals and maximize financial and customer performance. Sets business direction, develops, and implements and oversees operational models to meet business requirements for Health Plan Operations, Quality, and Network teams

Leads three teams (Operations, Quality, and Network), plus matrix responsibility for other functional teams including but not limited to Billing and Enrollment, Claims, Encounter Reporting, Payment Integrity, Member Call Center, Provider Call Center, Provider Data Operations, IT, and DSNP Product Team

Ensures all operational activities conform to contract compliance for Medicaid and DSNP lines of business. Understands state and federal legal and contractual regulations and requirements; translate requirements into operational metrics and protocols

Supports the development and execution of strategies to maximize growth, member retention, innovation, and member/provider experience for all products (Medicaid and DSNP)

Supports internal and external audits and accreditation activities

Owns business analysis and successful implementation of new contractual requirements.

Meets with state customers and regulators to collaborate on program improvements and customer program goals

Primary lead for monthly state oversight meetings; Develops and implements strategies to maximize performance on annual state partner survey

Partners with Compliance Officer to manage process for timely and accurate regulatory reporting (non-financial) to Rhode Island Executive Office of Health and Human Services (EOHHS)

Manages health plan staff/matrix staff responsible for delegated Subcontractor oversight, and onboarding and monitoring of vendors/subcontractors

Develops collaborative relationships with and confirms business partners can execute day-to-day responsibility for operations (member services center, enrollment, technology, DSNP Product etc.)

Serve as the link between health plan requirements and national support functions, including requests for program changes, implementation, training, etc., balancing local customization with national scale and efficiency

Drive collaboration between health plan and shared service partners to use audit and reporting metrics to ensure performance against contractual and regulatory requirements

Supports health plan leadership team to implement new, quality and affordability initiatives. This includes heavy emphasis on business analysis as well as defining data strategy, data acquisition and data analysis needs to evaluate strategies and operationalize new programs

Identifies and remediates performance issues and assist department leads in resolving complex technical, operational, and organizational problems

Identifies and implements performance opportunities including those to improve Member experience and Provider experience, efficiency, and accuracy. Owns end-to-end process improvement: definition of need, project plans, status updates, reporting and achieving results

Provides strategic leadership of provider network strategy to drive growth and performance, including oversight of Medicaid Accountable Entity (ACO) program

Informs and advises management regarding State’s current trends, and problems and activities to facilitate both short- and long-range strategic plans to improve operational performance and enhance growth

Ability to be in the office to meet business requirements

Limited travel (25%)

Leadership Expectations: Demonstrate Leadership and Cultural ValuesDeliver value to members by optimizing the member experience and maximizing member growth and retention

Lead and influence Health Plan employees by fostering teamwork and collaboration, and driving employee engagement and leveraging diversity and inclusion

Lead change and innovation by demonstrating emotional resilience, managing change by proactively communicating the case for change and promoting a culture that thrives on change

Drive sound and disciplined decisions that drive action while effectively using financial knowledge and data to manage the business

Drive high-quality execution and operational excellence by communicating clear directions and expectations

Experience within healthcare operations, quality management, network, and products and benefits

Customer-focused; proven ability to handle complex situations, resolve conflicts and issues effectively. Sensitive to how people and the organization function

Demonstrated ability to translate strategic objectives into action plans and lead / motivate teams to execute plans effectively; flexibility to adapt and change direction as needed

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:Bachelor’s degree

5+ years of related managed care experience

5+ years of leadership experience

5+ years of experience in matrix environment

Knowledge of and experience related to publicly funded government health care programs (e.g., Medicaid, Medicare, or State health care programs for the uninsured)

Technical and financial understanding of health plan operations

Working knowledge of relevant federal and state regulations and requirements pertaining to Medicaid and Medicare?

Ability to travel 25%

Ability to be in the office a minimum one week a month to meet business requirements

Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation

Preferred Qualifcations:Master's degree

In depth understanding of challenges that face health plans and health care in general

Exceptional leadership skills and operational management expertise

Excellent communication skills

Advanced analytical and problem-solving skills

Ability to stay apprised of ongoing changes that impact health plan operations

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employmentCareers 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 do your life's best work.(sm)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.

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