UnitedHealth Group Associate Health Services Director – Houston, TX in Houston, Texas

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm)

The Associate Health Services Director (AHSD) provides strategic leadership and is accountable for community dwelling nursing facility level of care membership for both our Medicaid and MMP members also serviced by the health plan. This individual is responsible to ensure contractual compliance and achievement of clinical, quality / affordability, and utilization management goals for all products. The AHSD serves as the primary point of contact and is accountable for all aspects of product health plan clinical and utilization management performance for the designated lines of business. Because of the unique structure and alignment of clinical programs within United Healthcare, this role requires a high degree of coordination with external and internal business partners, and other clinical specialty, external vendors and / or national programs.

The AHSD will work collaboratively with the Health Plan Director of Quality and Plan Medical Director to support achievement of state and federal quality and STAR initiatives. Additionally, this individual will work collaboratively with the Plan Medical Director, business partners and Finance to develop, implement / execute the Healthcare Affordability Plan, monitor outcomes of the planned initiatives and adjust the Plan as needed to meet targets. This individual will support the Compliance Program in promoting awareness of applicable program regulations that define the standard of organizational values regarding regulatory compliance. The Associate Health Services Director must possess a solid knowledge of all applicable lines of business, product and cohorts within the health plan operations from a clinical standpoint.

Primary Responsibilities:

  • Develops and enhances solutions to address new, often complex customer requirements that address Nursing Facility operational, clinical and customer needs.

  • Ensures adequate and appropriate staffing to support contract requirements.

  • Develops standardized benchmarks and “best practices” across all SDAs.

  • Reviews operational and performance metrics regularly and drives action plan development and execution.

  • Responsible for collaborating with State partners and providers to support appropriate execution on Managed Medicaid program benefit goals and initiatives

  • Provides input into forecasting and planning activities.

  • Works closely with team to ensure that monthly and annual targets are being met.

  • Develops and maintains standardized outcomes and productivity reporting.

  • Develops and maintains standardized policies and procedures.

  • Provides oversight of appropriate data collection activities and reporting for Executive team and customer requirements.

  • Supervises staff setting clear and consistent performance expectations.

  • Develops and recommends strategies for targeting business opportunities and implements approved strategies to efficiently and effectively grow the business.

  • Develops internal review guidelines, operational review processes and procedures to ensure contract deliverables while maintaining high quality and performance standards across all contracts.

  • Develops presentations and other documents related to clinical operations for customers or other internal customers.

  • In coordination with the Quality Management Department, develops and maintains quality standards.

  • Will work in conjunction with other teams for MMP and DSNP SOP and workflow development

Required Qualifications:

  • Active RN licensure in State of Texas

  • Bachelor's Degree in business, nursing, or related field Master's Degree Preferred

  • 3+ years progressively responsible healthcare leadership experience

  • Significant experience in development and execution of clinical programs in public sector integrated model managed care environment (5+ years)

  • Computer / typing proficiency including use of Microsoft Office Suite applications

  • Problem solving proficiency; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action

  • Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others

Preferred Qualifications:

  • Medicaid managed care experience in facility-based long term services and support

  • Masters in Nursing or related area

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 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.