If you want to achieve more in your mission of health care, you have to be really smart about the business of health care. Challenge yourself, your peers and our industry by shaping what health care looks like and doing your life's best work.
Clinical Performance (CP) is charged with effectively implementing, monitoring, and executing on clinical documentation, quality, and affordability programs that promote patient health while improving the provider practice experience with a special focus on Medicare Risk Adjustment and HEDIS. Clinical Performance processes on a national level by providing support in all markets served by OptumCare Delivery.
This position will report into the Director of Risk Adjustment Submissions and will be overall responsible for the design, development and delivery of technology enablement tools and processes as it relates to Care Delivery Organization (CDO) Risk Adjustment program data.
Business owner for design, development and delivery of technology enablement tools and processes to support the processing of Risk Adjustment program data
Coordinate, consult and manage resources to ensure successful delivery of technology enablement tools and processes
Facilitate regular touch points with leader to provide updates and identify risks and opportunities to technology platform
Diagnose process improvement opportunities and develop solutions using principles of process excellence and related tools
Partner with business owners and co-leads to ensure data for dashboards and operational metrics/reporting is complete and accurate
Collaborates with operational partners to drive productivity and efficiency
Critical Success Factors:
Ability to effective lead, manage and deliver in a fast paced, ever changing environment
Extremely creative at solving complex problems with strong analytical ability to recommend solutions
Understanding of CMS Risk Adjustment and ICD-10 coding requirements and regulations
Understanding of CMS encounter data submission and processing guidelines
Ability to effectively build and manage a team, including performance management, coaching / mentoring, and professional development
Working in a matrix environment to drive efficiencies through influence and relationships
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 or equivalent experience required; Master's degree preferred
5+ years of experience with SQL, Python programming languages
3+ years of experience with Talend software platform
5+ years of experience working with encounter data and submissions
3+ years of progressive leadership experience including leading operations, and/or business process improvement initiatives
Excellent knowledge of Excel
Experience working on multiple projects and help manage reporting resources
Technical mastery with experience creating and applying data analytics to solve business problems
Superior verbal and written communication skills
Ability to influence with and without direct management/authority
3+ years of experience with SAS programming
Excellent knowledge of MS Office (e.g., Project, Power Point, Visio, Access, Word)
Strong leadership skills with proven ability to foster and manage senior-level relationships in a highly matrixed environment
Superior customer/consultant relationship management and collaboration skills
Careers at OptumCare. We're on a mission to change the face of health care. As the largest health and wellness business in the US, we help 58 million people navigate the health care system, finance their health care needs and achieve their health and well-being goals. Fortunately, we have a team of the best and brightest minds on the planet to make it happen. Together we're creating the most innovative ideas and comprehensive strategies to help heal the health care system and create a brighter future for us all. Join us and learn why there is no better place to do your life's best work.(sm)
Diversity creates a healthier atmosphere: 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.