For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm)

As part of our CCOE business, we are expanding our credentialing portfolio to serve a diverse set of members and meet the needs our state and national partners. This new opportunity and role will be a key part of our CCOE Alignment team, supporting the newly-formed Policy Management & Vendor Management pillar. The Policy Program & Vendor Manager will directly support the business oversight of our National policy forms, National Credentialing Committee, and Vendor Management.

This position will have multiple responsibilities to support the successful, accurate, and timely filing of our policies, including tight alignment with NCQA requirements, internal audit process and market-specific business strategies and vendor management strategies. This position will serve a key role managing our source of truth information and supporting the further build out and business process. This role will also have responsibility for supporting the CCOE team in order to ensure that all related requirements are successfully executed. This role will also be responsible for managing relationships with vendors, stakeholders, and key decision makers in order to meet or exceed business goals. Acts as a single point of accountability for internal and/or external business partners.

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities

• Policy Program Management:
  • Serve as a key contributor on the CCOE team directly supporting the Policy Management pillar
  • Support Policy Management’s engagement with Regulatory, Legal, Clinical, Pharmacy and other business partners ensuring national state specific policies are in alignment with the regulatory environment
  • Maintain CCOE team’s Policy Repository (source of truth) documentation of all filed coverage, benefits, limits, and exclusions
  • Build and manage a robust and comprehensive database on mandates while offering consistent communication and education to our internal partners
  • Streamline internal documentation and prepare for internal automation in order to support the behind the scenes work completed by dedicated team members completing policy analysis as listed in the building accountabilities above
  • Build and manage a robust and comprehensive internal auditing program for the National CCOE team to adhere to
  • Exhibit solid understanding of business strategies and develop solid ties to matrix partners
  • Actively contribute new ideas and support ad hoc projects, including time-sensitive requests
• Vendor Management:
  • Develops communication documents and training criteria related to external client facing program success measures
  • Manages the execution of vendor agreements to ensure compliance, monitor quality, and develop corrective action plans
  • Managing the overall vendor performance per contractual service level agreements (SLA) and ensures vendors conformity to enterprise standards, operational processes, and management guidelines to ensure business goals and budget are achieved for an enterprise function
  • Participates in cross-function teams to implement vendor services
  • Drives continuous improvement activities and implementations across functional areas Recommends and implements vendor parameters regarding vendor production and quality in support of business objectives
  • Provides SME support in construction performance-based, accountability-driven vendor/business partner agreements, statements of work and action plans and procedures as needed
  • Facilitates the planning and implementation of the transition of new work items assigned to the vendor in support of strategic goals and budget Reviews, reconciles, and pays vendor invoices
  • Works with business representatives to assure that all aspects of implementation run smoothly
  • Manages and presents vendor dashboards, mitigation plans, ad-hoc reports & projects to senor leadership
    

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:

• Undergraduate degree or equivalent experience
• 5+ years of relevant healthcare experience in product or program management role
• 3+ years of vendor management experience
• 3+ years operational process management and improvement
  

Preferred Qualifications:

• Master’s degree
• 3+ years credentialing experience
• 3+ years policy management experience
• NCQA experience
• Proven analytical skills and ability to review data and make fact-based decisions and/or recommendation
• Demonstrated ability to balance strategic thinking with the urgency to drive work forward
• Proven adapt quickly to changes in work direction and able to pivot work accordingly
• Proven develop creative solutions to complex problems
• Proven team player with solid ability to form working professional relationships
  

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)

OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare’s support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.

California, Colorado, Connecticut, Nevada, New York, Rhode Island, or Washington Residents Only: The salary range for California, Colorado, Connecticut, Nevada, New York, Rhode Island or Washington residents is $85,000 to $167,300. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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.

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

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.

Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.