Director of Clinical Optimization - Remote

Primary Responsibilities

• Single point of contact for UnitedHealth Care Strategic Client Executives and Optum Strategic Account Executives for a portfolio of strategic National and Key Accounts.
• Serves as the program director for clients including managing population of over 360K members and 50+ clients with specific focus on partnership with the consultant (Mercer) including intense support, including HCC reviews and onsite strategy meetings.
• Accountable for the end-to-end operational performance against Customer deliverables within Population Health Service delivery.
• Ensures scalability and sustainability of Customer specific operational processes delivering against Customer commitments.
• Drives Customer performance against quality metrics; communicates customer status and remediation action plans.
• Proactively identifies and mitigates potential service gaps and customer specific quality opportunities ensuring a timely resolution.
• Maintains and manages to client-specific clinical performance guarantees (CPG) and claims trend guarantees (CTG).
• Contributes to client-facing presentations of program performance results in health plan reviews and Customer partnership meetings.
• Participates in Customer specific implementation meetings (internal & external), including client transitions as necessary; conducts post-implementation system audits.
• Partners with clinical team & leadership to identify, implement and monitor outcome- based strategies tailored to Customer-specific culture and membership.
• Collaborates with internal and external programs to ensure strong integration with clinical programs and efficient vendor referral processes.
• Proposes, implements & monitors customer-specific service delivery pilots to address efficiency opportunities and process gaps.
• Develops and leads execution of continuous improvement initiatives to ensure exceptional member experience and Customer satisfaction.
• Engages in Customer audit preparation meetings, including initial scope discovery meetings; partners with the Audit Team, Operations and Product to prepare pertinent materials and slides.
• Manages post Customer audit action plans to completion through accountable owners.
• Participates in finalist meetings and contributes to renewal RFPs demonstrating expertise and knowledge of their membership.
• Contributes to and participates in 1) AMT & Partnership meetings, as defined by purchased product, 2) QBRs to provide Customer-specific commentary on remediation plans, 3) external Customer & vendor meetings.

Required Qualifications

• 2+ years of managed care clinical operations or account management experience.
• 2+ years of customer/client presentation experience.
• Experience managing client and stakeholder relationships: internal (staff, matrixed resources) and external (client, carrier, consultants & vendor).
• Experience in negotiations and gaining consensus across a multidisciplinary team (internal & external partners) to include Clinical Consultants, product, and account management.
• Program management experience.
• Experience analyzing and interpreting customer/client data and making recommendations to operations / clients based for improvement based on data.

Preferred Qualifications

• Registered Nurse with active RN license.
• 5+ years of Call Center operations experience.
• 3+ years of experience as a Registered Nurse in a clinical setting.