No industry is moving faster than healthcare. And no organization is better positioned to lead healthcare forward. We need attention to every detail with an eye for the points no one has considered. You'll help improve the health of millions. And you'll do your life's best work.(sm)
Positions in this function generate forecasts and analyze trends in sales, SG&A, provider performance, product line profitability, membership, medical costs, premium yields, and other areas of business.
UnitedHealthcare Medicare & Retirement Finance Team is seeking a Vice President to focus on Medicare Advantage Risk Adjustment & Medicare Part D Prescription Drug Events data. This key role will be responsible to provide strategic and operational leadership to a core team of actuarial and analytical resources, in additional to building and managing a strategic and operational partnership with Optum. The ideal candidate will successfully implement and deliver solutions that leverage data, reporting and analytics to inform business decisions and achieve revenue targets within the guardrails of legal and compliance requirements.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
- Advises Executive Leadership Team (ELT) of risk adjustment priorities, business needs and performance; directly engages with and influences ELT to drive key decisions and resource allocations
- Executes against strategic, tactical, and operational goals in partnership with market and regional leadership and cross-functional partners. Navigate and influence multiple cross-functional teams in a complex, matrix work environment
- Defines short and long-term roadmap for analytical reporting for risk adjustment revenue and programs, in addition to Part D prescription drug event data and programs, to ensure performance improvement, program compliance, and financial objectives are achieved
- Lead team responsible for producing monthly Medicare Advantage and Medicare Part D forecasting and accruals of more than $80B annually; in partnership with FP&A and Controllership, develop and produce analytics to support Product Development and Bid team as needed to offer industry-leading, competitively priced MA and Part D plans
- Responsible for defining analytical solutions that meet or exceed revenue goals in partnership with UnitedHealth Networks, IT, Shared Services, UnitedHealthcare Clinical Services, and Optum
- Partner with Optum to ensure necessary technology is available to support accurate and complete transmission of risk adjustment data and prescription drug event data to CMS
- Strategic alignment with Optum on the design and development of prospective and retrospective risk adjustment programs
- Ensure organization can meet compliance reporting requirements for federal regulators
- Partner with ELT, Legal, Compliance and Regulatory Affairs on Advocacy efforts related to risk adjustment
- Partner with Legal on litigation matters related to risk adjustment
- Act as subject matter expert in risk adjustment including oversight of CMS initiated audit programs and defining / executing upon internally developed audit programs
- Establish a trusted-advisor relationship with CMS and respond to their inquiries; pre-COVID, this included in-person meetings with the CMS MA risk adjustment teams
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.
- Bachelor’s degree in Healthcare Administration or a related field
- 10+ years of leadership and management experience in a health care organization
- 7+ years of direct experience with Medicare Advantage risk adjustment analytics and a demonstrated ability to identify opportunities and design programs to capture value
- 3+ years of experience with the Medicare Part D program
- Experience managing vendor relationships
- Expert level of proficiency working in a fast-paced matrix organization with a proven track-record of managing, prioritizing, and delivering upon multiple programs that drive tens of billions of dollars
- Proven ability to effectively advocate / problem-solve as necessary to obtain desired outcomes and meet legal and regulatory requirements
- Proven ability to work collaboratively with Legal, Compliance, Regulatory Affairs, Clinical, Accounting, IT and Operations, including the ability to proactively identify issues and execute solutions
- Well-developed written and verbal communication skills
- Poise and confidence necessary to influence and drive decisions with Executive Leadership Team
- If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained.
- Prescription drug event transactions experience
Careers at UnitedHealthcare Medicare & Retirement. The Boomer generation is the fastest growing market segment in health care. And we are the largest business in the nation dedicated to serving their unique health and well-being needs. Up for the challenge of a lifetime? Join a team of the best and the brightest to find bold new ways to proactively improve the health and quality of life of these 9 million customers. You'll find a wealth of dynamic opportunities to grow and develop as we work together to heal and strengthen our health care system. Ready? It's time to do your life's best work.(sm)
Colorado Residents Only: The salary/hourly range for Colorado residents is $169,500 to $322,500. The role is also eligible to participate in UHG’s annual bonus and long-term incentive plans. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.
*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: Minnetonka, Minnesota, MN, 926151