Executive Director, Medicare & Retirement Texas

About the position

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us in making healthcare work better for everyone through people-led, responsible AI while Caring. Connecting. Growing together.

The Medicare & Retirement Executive Director is accountable for all aspects of the P&L within a given market, with primary responsibility for defining, leading and driving local initiatives to achieve five Star CMS rating, Coding, Growth, Building Medicare networks, Retention of Medicare members and Affordability goals. The Executive Director sets strategy and prioritization with national shared service partners specific to the local market and ensures cross-organizational alignment.

In this role, you are the face of M&R in your market. You will establish and maintain clear leadership credibility and partnership with our external provider and broker partners. You are responsible for identifying and leading new business strategies and initiatives to meet the needs of our members. These strategies will impact Medicare Advantage product development and planning, new business ventures, and market expansion. This role will report directly to the Health Plan CEO.

If you are located in Texas, you will have the flexibility to work remotely as you take on some tough challenges.

Responsibilities

• Serve as the Medicare market strategist of market health care delivery, business development, payment model innovation, and policy integration, establish have solid provider partner relationships
• Actively collaborate with all Medicare & Retirement national functions (Product, Sales, Marketing, Member Experience, Finance), UnitedHealthcare shared services functions (Network, Clinical, Quality, Operations) and Optum (Local Care Delivery, HouseCalls, Complex Population Management) functions to leverage local market knowledge and establish and drive plans across all levers of the P&L
• Define and own execution of the Provider Engagement strategy utilizing both National and local initiatives; establish solid, collaborative relationships with providers in support of all Quality, NPS and Affordability goals; work collaboratively with Optum, UHN and UCS partners
• Work cross-organizationally with local health plan team, Network, Market Medical Director and Optum Stars to identify and execute new business opportunities, including bundled payment models, post-acute care innovation, and ACO acceleration and proliferation
• Work cross-organizationally with local health plan team, Network, Market Chief Medical Officer and Optum to increase suspect closure, recapture, and prevalence improvement inclusive of increasing HouseCalls completion rates and reducing refusal rates
• Provider contract set up and offerings – Capitation, delegation, risk, FFS, MAPCPi/MCAIP, ACO, MAIP
• Assist UHN and roster managers with provider loading and accuracy of information - Sign off on loading instructions, source of truth and breakout documents
• Involvement in provider facing JOC meetings to discuss market performance, strategy around STARS, CAHPS, HOS and RAF. Partner with internal teams of QFO, ACO and Optum to drive goals
• Identify and execute on Affordability opportunities aligned with market goals
• Participate in defining and owning execution of the Growth and Retention strategy in partnership with Distribution; be the face of the market to external channels
• Act as the voice of the market for print and media interviews
• Help define and support execution of the Stars strategy, utilizing both National and local initiatives, inclusive of HEDIS, Part D, CAHPS and HOS to achieve 80%25 of members in 4+ star plans
• Identify and prioritize market barriers both internally and externally to enable teams to be more productive. Ability to work quickly and independently to ensure quality, coding and utilization stays on trend

Requirements

• 5+ years of experience in a large, complex and successful health care / managed care organization with demonstrated track record of increasing responsibility and / or accountability
• In-depth experience with health care providers / networks, CMS Star ratings, HEDIS measures, Part D and / or clinical quality
• Demonstrated success building relationships with external executives and stakeholders
• Proven track record of meeting business goals via driving disciplined, fact-based decisions and executing with discipline and urgency
• Proven solid written and verbal communication skills, including well-developed interpersonal skills used to influence the behavior of others across a highly matrixed organization
• Demonstrated intermediate or higher level of proficiency with MS PowerPoint and Excel and new AI tools to help create operational efficiencies
• Proven ability to present complex information to C-Suite Leadership
• Ability to travel 25-35%25 of the time within an assigned territory
• Reside in Texas

Nice-to-haves

• Experience in Medicare Advantage or other government-funded healthcare business
• Demonstrated financial acumen and solid analytical skills
• Demonstrated excellent written and verbal communication skills, including well-developed interpersonal skills used to influence the behavior of others across a highly matrixed organization

Benefits

• a comprehensive benefits package
• incentive and recognition programs
• equity stock purchase
• 401k contribution