Director, Population Health Payer Programs

UnitedHealth Group • El Segundo, CA

243d • $106,800 - $194,200 • Onsite

About The Position

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 to start Caring. Connecting. Growing together. In this role, you will be responsible for providing direction and guidance on clinical quality improvement and management programs, including accreditation. You will act as the direct interface between Optum and affiliated health plan networks to support their operations and quality improvement performance. This position includes continuous education, support, training, and troubleshooting for physicians and their staff. You will conduct clinical quality audits and may be responsible for NCQA requirements, focusing on the reporting and analysis of member care quality and the development of plans and programs to support continuous quality improvement using tools like HEDIS.

Requirements

• 5+ years of clinical experience
• 3+ years of clinical quality management experience
• 3+ years of experience working in managed care or the insurance industry
• Proven ability to lead with strategic direction, develop tactical plans, and drive performance to meet targets
• Solid presentation skills, with experience delivering formal presentations to senior leadership
• Proven expertise in managing large-scale population health programs and value-based care models
• Solid knowledge of healthcare regulations, risk stratification, and quality performance metrics (HEDIS, STAR ratings, Medicare Advantage, Medicaid)
• Exceptional ability to collaborate with executive leadership, providers, and cross-functional teams

Nice To Haves

• Experience in California with a deep understanding of regional healthcare regulations and payer/provider landscapes
• Background in integrated delivery systems, accountable care organizations (ACOs), or large medical groups

Responsibilities

• Serve as the single point of contact for Optum California Quality Improvement/Risk Adjustment, ensuring accountability and responsiveness to health plan quality improvement needs
• Monitor quality and risk performance of affiliated health plans, identify areas of underperformance, and work with leadership to develop action plans for improvement in key metrics
• Collaborate with internal Optum QI teams to ensure accurate and timely reporting of health plan data and work closely with health plan QI teams to implement and monitor action plans
• Escalate and intervene in QI health plan issues when necessary, collaborating with teams to resolve issues effectively
• Provide leadership and direction to multiple layers of management and senior-level professional staff
• Develop and execute strategies for the quality function that impact large business units or multiple markets/sites
• Make product, service, or process decisions that affect multiple functions or customer accounts
• Drive continuous quality improvement across the health plan networks, ensuring a high standard of care and performance
• Lead operational execution of population health programs, ensuring alignment with value-based care contracts and financial goals
• Drive optimization of care management workflows, provider engagement tools, and performance tracking systems
• Monitor key performance indicators (KPIs) to measure the success of population health initiatives, including utilization, cost, and quality outcomes
• Oversee implementation of innovative care delivery models such as remote patient monitoring, digital health, and community partnerships
• Foster strong relationships with healthcare providers, payers, and community organizations to enhance care delivery and coordination
• Collaborate with regional and national Optum leaders to align strategies and share best practices
• Engage with provider networks, health plans, and government agencies to enhance partnerships and advocacy effort

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Industry: Insurance Carriers and Related Activities