Director Clinical Guidance and Effectiveness - Remote

UnitedHealth Group•Eden Prairie, MN

4h•Remote

About The Position

As a member of the Optum Care Delivery team, you will contribute to the vision of making healthcare better for everyone, leveraging clinical resources, data, and global organizational support to help patients live healthier lives. Optum aims to provide an exceptional career experience, empowering employees to thrive both professionally and personally. This role offers the opportunity to advance community health and contribute innovative practice ideas to improve care for millions. Within the Optum Health Clinical Excellence organization, this position drives strategic decision-making and supports clinical strategy, facilitating cross-functional execution and establishing a unified language and roadmap. The mission is to define and achieve clinical true north for Optum Health, streamline delivery systems, and empower system partners to deliver differentiated outcomes, ensuring patients live longer with better quality of life and clinicians are empowered to deliver optimal outcomes and experiences. The role involves applying clinical expertise and business acumen to guide Optum Health leaders and teams on clinical domains, projects, programs, and initiatives, aiming to build consensus for optimal business solutions that improve clinical and operational processes. Responsibilities include providing directives for best practices, driving standardization and optimization, and enhancing performance or financial outcomes. A strong understanding of Optum Health's structure is essential for proactive collaboration and influencing cross-organizational clinical program activities, as is building relationships with clinical, product, and business teams to shape the future of the business.

Requirements

5+ years of experience in the managed care or health insurance industry (government programs, network management, legal, or compliance)
5+ years of experience in data analysis, process documentation, and process improvement
5+ years of project management experience
Experience leading teams through organizational change and transformation
Demonstrated ability to influence and motivate stakeholders at all organizational levels
Proven success operating in complex, matrixed environments with strong systems-thinking capability
Proven solid strategic thinking with a consistent record of execution and results accomplishment
Proven advanced critical thinking, analytical, and problem-solving skills
Proven excellent written and verbal communication skills
Proven ability to manage multiple competing priorities with agility
Proven solid growth mindset and demonstrated ability to leverage innovation

Nice To Haves

PMP or CPHQ certification
3+ years of experience in clinical policy or clinical guideline development

Responsibilities

Lead the scoping and prioritization of national clinical guidance initiatives in collaboration with Risk, NOCMO, AI teams, Technology, and other enterprise partners
Establish a unified clinical roadmap aligned to evidence-based standards, regulatory requirements, and organizational strategy
Partner with clinical leadership to ensure guidance is current, clinically sound, and scalable
Collaborate with value-based care, clinical models of care, optimal care, and high-value care teams to ensure guidance meets business and clinical needs
Facilitate cross-functional forums to drive alignment, resolve concerns, and build consensus
Influence without authority in a highly matrixed environment
Provide leadership and direction to the Clinical Guidance & Effectiveness team
Oversee daily operations including project management, analytics, prioritization, workflow optimization, and reporting
Implement and monitor efficient, repeatable processes for guidance development and maintenance
Develop and execute strategies for the creation, implementation, and lifecycle management of clinical guidelines and supporting materials
Standardize best practices while identifying opportunities for innovation and process improvement
Ensure guideline development meets quality, timeliness, and compliance standards
Direct resolution of complex business and clinical challenges related to guidance development
Navigate stakeholder conflicts, resource constraints, and regulatory considerations
Provide strategic, operational, and administrative recommendations in response to emerging conditions
Track progress against timelines, KPIs, OKRs and performance metrics
Collect and analyze stakeholder feedback to assess effectiveness and impact
Drive continuous improvement in quality, operational efficiency, and financial performance
Build strong internal partnerships across clinical, operational, product, and technology teams
Maintain relationships with external entities including medical societies, academic research centers, and regulatory organizations
Communicate transparently and regularly on progress, outcomes, and next steps
Ensure adherence to organizational policies, procedures, and regulatory requirements
Stay current on compliance changes affecting clinical guideline creation
Educate and enable teams on compliance expectations and standards