Job Information

UnitedHealth Group Director of Medical Management, TRICARE in Eden Prairie, Minnesota

At Optum, the mission is clear: Help people live heathier lives and help make the health system work better for everyone. OptumServe provides health care services and proven expertise to help federal government agencies modernize the U.S. health system and improve the health and well - being of Americans. By joining OptumServe you are part of the family of companies that make UnitedHealth Group a leader across most major segments in the U.S. health care system. OptumServe offers customizable solutions to serve the diverse needs of commercial customers, as well as federal and state agencies, including the U.S. Departments of Defense, Veterans Affairs, and Health and Human Services.

There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Ready for a new path? Start doing your life's best work.(sm)

The Director for TRICARE Medical Management is responsible for development of an integrated Medical Management Program for inclusion in the Response to Proposal (RFP) for the Defense Health Agency Managed Care Support Contract for the Military Health System (TRICARE) contract to include development of the Medical Management delivery model, Plan, and implementation upon award.

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

Primary Responsibilities:

  • Lead development and documentation of an integrated Medical Management Program solution to meet the Statement of Work (SOW) requirements, contributing to the RFP for the TRICARE contract.

  • Guide a team of subject matters experts for population health, Case Management, Clinical Quality and Utilization Management to develop components of the overall Medical Management solution model of delivery and develop and write the contractually required Medical Management Plan.

  • Work integrally with organizational teams to understand contractual performance for the SOW, identify business requirements, conduct gap analyses to inform solution design and drive effective Medical Management solution

  • Oversee development and implementation of detailed project management plans to identify and schedule all activities required to complete development of the Medical Management Program components and transition/implementation upon award

  • Identify and effectively articulate needs required to development and implement the Medical Management solution to Program Management team and executive leaders as needed

  • Assign, direct and monitor development work to subordinate team members ensuring focused and sustained progress to meet suspense dates leading to delivery of a complete and acceptable Medical Management Plan

  • Identify critical operational and system elements for inclusion in Medical Management and Clinical Quality Management Plans

  • Work with approved vendors and organizational teams to incorporate required elements such as population health programs into the overall Medical Management solution

  • Ensure incorporation of National Committee for Quality Assurance (NCQA) standards for Case Management, Utilization Management and Population Health into the Medical Management Program.

  • Evaluate and use clinical quality data analysis to inform and develop strategy for development and implementation of the Medical Management Program

  • Work with the Medical Director to identify and solve for program medical/clinical issues during program development and implementation

  • Prepare and present progress or other reports to Program Management and Executive Leaders.

  • Complete the Medical Management Basis of Estimate (BOE) for inclusion in the overall TRICARE proposal BOE

  • Upon contract award, develop and execute a transition plan to include hiring and training of operational staff to meet, development of policies and procedures, identification of program goals

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:

  • Active, unrestricted Registered Nurse (RN) or Nurse Practitioner (NP) license, or independent clinical social work license (LCSW, LICSW, etc.)

  • 15+ years of clinical experience in a healthcare system

  • 10+ years of experience in Medical Management

  • 5+ years progressive Medical Management leadership/supervisor experience

  • Program development and implementation experience

  • Clinical quality experience and/or certification

  • Ability to use/learn computer and web-based applications

  • Proven ability to direct, manage, prepare project documentation and present reports, recommendations, and program plan

  • Ability to work effectively across organizational work teams

  • United States Citizenship

  • Ability to obtain favorable adjudication following submission of Department of Defense form SF86 NAC form SF86

  • If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders

Preferred Qualifications:

  • Master’s degree in Nursing or Healthcare Administration (or other related advanced degree)

  • Certified Case Manager (CCM)

  • Experience with TRICARE Managed Care Support Contracts/Military Health System

  • Excellent interpersonal, communication, team building and writing skills

  • Solid statistical, analytical and independent problem-solving skills at a program level

  • Expresses ideas clearly and effectively both verbally and in writing; uses appropriate organization, structure and grammar in written communication

  • Ability to educate, motivate, and/or influence others to understand clinical processes

  • Experience managing a remote team

Optum, a part of the UnitedHealth Group family of businesses, continues to evolve and make a bigger impact through its extensive expertise in combining technology, data and people to create novel health care solutions and services across the globe. OptumServe is following suit by creating and delivering care that meets the health needs of active duty service members, veterans and their families. We're partnering with federal and state government agencies to meet the readiness and health needs of active duty military members and veterans by providing preventive health screenings and assessments to ensure that troops are ready to answer the call of duty. For those who want to intensify their impact in a career that brings together challenge, learning and growth, OptumServe is the right place to do your life's best work. (sm)

Colorado Residents Only: The salary range for Colorado residents is $110,200 to 211,700. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy

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: RN, registered nurse, case management, medical management, quality management, utilization management, program management, implementation, TRICARE, social work, LCSW, LICSW, military, telecommute