UnitedHealthcare's Virginia Medicaid Plan, INTotal Health, seeks a full time Director, Healthcare Economics, Planning & Analysis. As a member of the leadership team, the position is responsible for managing and driving the clinical and financial analytic functions of the health plan to support the achievement of membership, premium, medical expense, gross margin and SG&A goals. Works collaboratively with all departments of the health plan to ensure the organization is focused on the acquisition and utilization of clean, accurate and complete data in a systematically sound manner to gain insight into all aspects of the business and to drive knowledge-based decision making. Primary Responsibilities:Provide necessary information for estimation and valuation of health claims liabilities, including detailed analysis for auditor review, within required timelines of the monthly close process Direct and manage external third-party vendors providing HCE-related services Support analytics, bill auditing, warehousing of clinical and financial data, dashboard reporting, risk accuracy, and data/encounter submissions to external parties Monitor monthly claims workflow/production, including investigation and resolution of adverse changes in production statistics and their impact on medical accrual estimates Direct data integration, data analytics, and predictive modeling processes to meet business requirements Identify trends & key drivers in revenue and medical expenses Ownership of the Business Initiative process to analyze and optimize medical spend and ensure success for the health plan in establishing and achieving revenue, medical and gross margin targets on a routine basis according to forecasts Participation in the premium rate-setting process Support the annual HEDIS cycle and the Provider Incentive Programs Ownership of the risk accuracy improvement process and manage/coordinate the cross-functional prospective and retrospective initiatives involving internal resources and vendors relating to the accuracy of coding and CDPS risk scores Ownership of IBNR data workflow, monitoring of trends, maintenance of models and suggestions for enhancements to more accurately estimate claims liabilities Identify and drive opportunities for savings with Plan leadership on a regular
Required Qualifications:Mentors, leads and directs staff including day-to-day supervision, employee relations and staff development Proficient in Microsoft windows environment including Office Suite Advanced skills with database/spreadsheet programs such as Microsoft Access and Excel Advanced analytical skills and the ability to solve unstructured problems Skilled leader with excellent communication and people management skills Ability to clearly discuss complex analytical concepts with individuals and groups Experience in HEDIS, CDPS, medical coding and medical billing concepts 6 years analytics experience in a health plan with progressive responsibility At least 2 years leadership experience, including hiring, developing and/or managing staff Experience in database design and maintenance Documented success in facilitating multi-disciplinary teams in analyzing and improving medical and financial trends Bachelor's degree in related fieldPreferred Qualifications:SPSS and SQL, or equivalent experience, preferred Master's degree in a field related to healthcare analytics/biostatistics highly preferredCareers 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. Job Keywords: Director, Economics, Manager, Falls Church, VA, Virginia
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.