Executive Director, Clinical Transformation and Delivery Position Available In Davidson, Tennessee

Executive Director, Clinical Transformation and Delivery – Remote in Greater Nashville, TN Area

Requisition Number:

2288719

Job Category:

Medical & Clinical Operations

Primary Location:

Nashville, TN, US
(Remote considered) 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 equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. The Executive Director of Clinical Transformation and Delivery provides strategic leadership, direction and oversight of all clinical (to include Quality, Behavioral Health, SDOH and Value Based) programs for all Medicaid and DSNP membership served by the Tennessee Community and State Health Plan. This leader innovates care programs to benefit Tennesseans. Their planning and oversight ensure clinical activities align with UHC’s strategy, mission, and values. Success depends on delivering results and sharing UHC’s mission of healthier lives while managing costs and providing quality and value. The ED of Clinical Transformation and Delivery role requires a high degree of collaboration and coordination with external and internal business partners, including, but not limited to the Bureau of TennCare, UHC-Clinical Services, Appeals and Grievance, Quality, Provider Network, Optum case and disease management, Healthy First Steps, NICU, SDOH, Optum Behavioral Health, Optum Advisory Services, Medicaid partners and other clinical specialty, external vendors and stakeholders or national programs. This role also ensures achievement of state quality initiatives, HEDIS measures and compliance with relevant requirements of the state’s annual Performance Review(S) conducted by the External Quality Review Organization (EQRO), state or other oversight body and meeting NCQA requirements. Additionally, the ED of Clinical Transformation and Delivery works collaboratively with the Plan’s Executive Leadership Team (ELT) (Chief Medical Officer, Chief Operating Officer, Chief Financial Officer, Compliance Officer and Long Term Care Support Services Executive Director) and MATRIX partners to develop, implement / execute the Healthcare Affordability Plan, monitor outcomes of the planned initiatives, and adjust the Plan as needed to meet targets. The ED of Clinical Transformation and Delivery must possess a solid knowledge of all lines of business, products, and cohorts within the health plan operations from a clinical standpoint. This includes TANF, ABD, CHIP and DUAL Medicare programs. The ED of Clinical Transformation and Delivery serves as the Tennessee Health Plan’s primary point of contact for all aspects of health plan clinical, SDOH, value and quality performance. The ED of Clinical Transformation and Delivery reports to the Tennessee Health Plan Community and State CEO and directly leads a health plan staff of 130+ people, while providing direction to a large, matrixed team across the enterprise to successfully implement complex business processes. If you are located in the greater Nashville, TN area, you will have the flexibility to work remotely• as you take on some tough challenges.

Primary Responsibilities:

Strategic Leadership In partnership with the Health Plan’s ELT provides leadership and accountability for the design, deployment, implementation and management of integrated clinical (physical & behavioral health), SDOH, quality/affordability programs that optimize clinical and health outcomes of Tennessee Medicaid recipients
In partnership with the plan’s ELT, provides leadership and accountability for the design, implementation and management of integrated physical health, behavioral health and SDOH services through our PCMH provider partnerships for the improved health outcomes of Tennesseeans
Drives impactful Community Giving campaigns that augment our clinical programs for improved health outcomes of Tennessee Medicaid recipients and differentiates UHC from its competitors
Develops effective/efficient member and provider engagement strategies through integrated PCMH, VBC, SDOH and THL communications, education and collaboratives resulting in improved provider performance and member health outcomes
In partnership with UHN Contracting and ELT, develops value based contracting strategies that align incentives around quality outcomes and affordability
Collaborates with large provider organizations to develop innovative population health and value-based compensation models that support delivery of higher quality and more cost-effective services
Represents United HealthCare and serves as a Thought Leader via “Outside of the Box” thinking when collaborating with State customer on member/provider engagement and improved health outcome initiatives
Works collaboratively across all business segments to design and develop innovative programs that result in a positive impact on Healthcare Quality and Affordability
Contributes to the development and execution of overall health plan innovations, strategies and key Initiatives through staying abreast of current clinical trends in technology and clinical delivery system advancements
Guides, develops, and trains leadership staff at various levels in their leadership skills Program Management and Coordination Leads health plan clinical teams, to include Population Health, Quality (NCQA Accredited) Case Management, Community Outreach, SDOH, Value Based Provider Engagement staff (~130+) to execute against strategic, tactical, and operational goals as defined by State, local and corporate leadership
Educates Matrix Partners on State requirements ensuring timely and quality delivery on state expectations
Leads the coordination and completion of projects with cross-functional teams and senior leaders across medical / nursing / clinical functional/provider Matrix partners to achieve targeted population health and quality performance goals
Actively participates in community outreach and networking activities to develop support and community infrastructure to meet member needs and promote member growth and retention
Actively embraces the United Culture and Values in working with both internal and external customers/stakeholders, as well as actively pursues incremental increases to Employee Engagement Survey results 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.

Required Qualifications:

Seasoned leader with 7+ years of healthcare management experience in a business, managed care or payer health plan setting 5+ years of experience developing and implementing innovative clinical strategies and programs for Medicaid and/or Medicare populations
Proven ability to develop and lead multi-level leaders
Proven ability to quickly diagnose and solve complex problems
Proven excellent influencing, negotiating, planning and decision-making skills
Demonstrated ability to lead business initiatives to a successful result
Proven experience working in a cross-functional environment and well-developed relationship building skills, willing to take a leadership role driving initiative, working across organizations and structuring approaches to new opportunities
Experience establishing and maintaining effective working relationships with employees, managers, healthcare professionals, physicians, executive leaders, and market leaders
Proven ability to effectively deal with ambiguity – can effectively cope with change, can shift gears comfortably, can decide and act without having the total picture, comfortably handle risk and uncertainty in a manner consistent with UnitedHealth Group’s core value
Reside in the greater Nashville, TN area •All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy The salary range for this role is $150,200 to $288,500 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment. Additional Job Detail Information Requisition Number
2288719 Business Segment
UnitedHealthcare Employee Status
Regular Job Level
Director Travel
Yes, 25 % of the

Time Country:

US Overtime Status
Exempt Schedule
Full-time Shift
Day Job Telecommuter Position
Yes