OptumCare focuses on transforming healthcare one patient at a time. The Enterprise Clinical Performance (CP) division specifically addresses the patient documentation and quality of care component. Through CP, OptumCare is positioned like no other healthcare system pulling together its resources of risk adjustment and management, quality initiatives, IT, and data analytics to streamline and drive at patient information to put actionable data in the hands of providers who deliver the safest and optimal care possible. CP is the nerve center for OptumCare's national network of clinical systems to reshape the healthcare landscape, harnessing trends, forecasting and sculpting best practices for the industry. The VP Risk Adjustment will report directly to the Senior VP, Centers of Excellence. This position will be responsible for strategic leadership, direction and operational support for CP initiative programs throughout Optum's local clinical care delivery systems. This area will focus on implementing, monitoring, and executing on government pay for performance programs with special focus on risk adjustment and HEDIS. This role will work in close collaborative partnership with the Medical Director of CP and will plan, organize and implement CP processes on a national level by providing support in all markets served by Optum Local Delivery. Primary Responsibilities:Provide long range planning and oversight of CP department operations to ensure activities are appropriately integrated into the strategic direction, mission and values of the companyProvide leadership and oversight of all market operations for CP to ensure processes are completed timely in accordance with company objectivesMonitor and track actual versus expected performance to target areas for improvementAssist in hiring staff for all markets and assuring adequate staffing is in place to meet market demandsProvide leadership and mentoring to management and staff in establishing objectives. Effectively lead and energize team functioning across geography and time zonesEnsure continued development and implementation of training programs for CP and oversee development of resources/reference tools for departmental staff, providers and other clinical staff as necessaryStrive to improve operational efficiencies and make recommendations as appropriate; take ownership of the total CP process and provide constructive information to minimize problems and increase provider and market satisfactionPartner with Local Care Delivery leadership teams and Optum management across markets to coordinate execution and implementation in all marketsDevelop and govern the annual budget for CP department operations and implements plans to achieve budgetary goalsProfessionally develops staff through effective identification and utilization of internal and external resources; conducts annual performance reviews and identifies high potential performers for succession planning purposes
Required Qualifications:5+ years of experience in all of the following areas:Risk Adjustment, including CMS Risk Adjustment experience with expertise in one or more lines of business and / or risk adjustment functional areas: Retrospective Chart Review and / or Prospective In – year Strong knowledge of ICD-10Quality with a working knowledge of HEDISOperational knowledge related to health insuranceManaging Direct Reports, including some at the Director level. This would include knowledge of staffing, training, coaching and employee discipline practicesExperience with coding and medical management initiatives10 years of combined experience within managed care / health insurance industry experience in government relations, network management, and / or legal / complianceExperience working with multiple levels and departments organizationally to accomplish defined objectivesProven track record in managing major projects and / or programsLead a complex or multi-functional / multi-location team / organizationAbility to effectively report data, analyze facts and exercise sound judgment when making recommendations to members of the Senior Leadership TeamProficiency with Microsoft Excel, PowerPoint, and Word50% travel Preferred Qualifications:Bachelor's degree, medical related field with risk adjustment / coding experienceSpecific program experience with Medicare Advantage Star Ratings and HEDISFamiliarity with Physician Practice Management or IPA OperationsExperience in Medicare ACO Programs, MACRA, MIPS & APM'sExperience with Medicaid quality and risk adjustment programsAccess highly preferredFamiliarity with other government pay for performance programsStrong Team Player 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) 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: Healthcare, leadership, Risk Adjustment, CMS, ICD-10, HEDIS, Health Insurance, project management, direct reports, managed care, government relations, Medicare, Medicaid, telecommute, telecommuter, telecommuting, remote, travel, work from home
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.