DSNP Executive Director, New Jersey - Remote in New Jersey and surrounding areas

UnitedHealth Group•Newark, NJ

7h•Remote

About The Position

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together. As the Executive Director, Dual Special Needs Plan (DSNP ED), you will have the unique opportunity to manage a complex, innovative, and growing product line in collaboration with local Market Medicaid leadership and our nationally leading Medicaid team. The DSNP ED role will focus on delivering overall product results, including growth, medical expense and revenue management, quality and clinical outcomes, and integration and coordination of Medicaid and Medicare benefits. As the DSNP ED you will be accountable for developing deep state relationships to support the annual State Medicaid Agency Contracts (SMAC) Process as well as shaping state Medicaid strategy for integration and benefit coordination. In addition, this role will require deep knowledge of local community based supports and demonstrated relationships with local Community Based Organizations (CBO) and Medicaid service organizations such as Single Entry Point (SEP) and Area Agencies on Aging (AAA). This role will also serve as the accountable leader for collaboration with the Medicare Product Team for annual benefits and bid filing strategy. Dependent on market size and integration level, this role will allow for the DSNP ED to manage multiple markets. The successful candidate will have a deep understanding of both Medicaid and Medicare, understanding the manner in which these two programs work together to promote health and wellbeing for the most vulnerable, including those receiving long term services and supports (LTSS). The candidate will have a demonstrated ability to work in a matrixed environment, including collaborative goal setting with the local market CEO and national product team leaders. The DSNP ED will lead medical expense management strategies to address emerging trends, will collaborate with national Quality team members to drive continual STAR Rating performance, and will lead with a Person-First mindset to ensure our Medicaid and Medicare programs fully support our membership across all domains of care. The successful candidate will also be responsible for fostering close, mutually beneficial relationships with local community supports and providers, including but not limited to primary care medical homes, health systems, behavioral health providers, community leaders, community-based organizations, policymakers and consumer advocacy groups throughout the states. The Executive Director is a driver of solutions and partnerships that increase STARS rating of the health plans, close gaps in care and service delivery for members, and continuously improve access to care in the communities served. As a key leader among the health plans, the Executive Director assures that the health plans and their partners live up to service commitments for the communities served. If you reside locally to New Jersey, you will have the flexibility to work remotely as you take on some tough challenges.

Requirements

4+ years of experience in Medicaid and/or Medicare programs environment, care delivery models, VBC/APMs
Experience in quality improvement, strategic planning and development
Experience designing and/or administering health programs and developing health care policy
Experience managing high-profile community projects or large-scale contracts
Consistent, progressive leadership experience in health care delivery and public programs
In-depth knowledge of the dual Medicaid – Medicare eligible populations including Behavioral Health and LTSS
People management, including direct supervisory experience and ability to indirectly influence those outside of direct supervision
Ability to travel up to 75%25
Reside locally to New Jersey

Nice To Haves

Knowledge of and experience with the Medicaid waiver process
Knowledge of and experience with Medicaid and Human Services systems within the served states, licensure processes, quality and financial oversight processes, including applicable federal and state regulations
All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

Responsibilities

Functions as a member of the executive teams for the C&S health plans being supported
Direct oversight of the Dual Special Needs Plan (D-SNP) for multiple states
Ensures compliance with applicable state and Federal laws and with contractual obligations to state Medicaid, providers and others
Product P&L ownership and matrixed and direct leadership across a complex organization
End-to-end ownership of all related functions for assigned D-SNP markets including:
The development of market specific State Medicaid Agency Contract (SMAC) agreements and accountability for ensuring compliance with SMAC requirements
Collaboration with Government Programs functional teams including but not limited to Product, Stars, Operations, Clinical, Sales and Marketing to ensure best in class delivery of Medicare Advantage programs
Identification of market specific requirements and alignment with national vendor (clinical/non-clinical) options to support cost effective, proven solutions
Maintain awareness of and apply emerging state and federal policy requirements to market specific strategies
In collaboration with clinical and Health Care Economics team, leads medical expense management strategies to manage trend and medical cost as well as promoting best outcomes
Reporting and Analytics – in collaboration with national HCE, Finance, and Operations, develops and retains detailed reporting to enable effective management of the program, including but not limited to: trend drivers (DX and Provider type), member demographics, RAF/HCC reporting, detailed financials, integration status, etc
Develop and execute strategic priorities related to Highly Integrated Dual Eligible (HIDE) & Fully Integrated Dual Eligible (FIDE) maturation, Accountable Care Organization (ACO) partnerships, community engagement, LTSS co-evolution including management of state relationship for DSNP integration (in collaboration with health plan CEO)
Defines strategic priorities to support contract, SMAC, Risk Adjustment Factor (RAF), STARS and other quality standards
Works closely with UHN partners to refine the DSNP network for optimal success including integration of providers, network adequacy and cost / quality / outcomes
Ensures matrix partners provide excellent service to state customers, i.e., members and providers
Works closely with Government Programs and M&R CEOs to align on priorities when appropriate
Assists in detecting service problems and coordinating solutions with the health plan, segments and corporate office
Understands thoroughly and administers the contracts for the line of business within the applicable states
Participates in formulating and administering company policies and developing long-range goals and objectives as they relate to the state health plans
Represents the health plan professionally and effectively to customers such as state Medicaid and other important business relationships
Establishes and maintains an excellent business reputation
Monitors state activities, costs, operations, etc. to determine progress toward objectives and priorities
Develop and maintain solid relationships within the key communities including providers, business partners, community alliances, etc.
Continuously fosters innovation, improvement and positive differentiation in the assigned markets