Health Services Director - New York

UnitedHealth Group•New York, NY

4d•$134,600 - $230,800•Hybrid

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 The Health Services Director (HSD) serves as the senior operational clinical leader for the UnitedHealthcare Community Plan of New York, accountable for the execution, compliance, performance, and continuous improvement of all care management and utilization management programs across Medicaid, Essential Plan, and Medicaid Advantage Plus (MAP). This role is designed for a proven leader who can operate at scale in a highly regulated environment, translate strategy into operational results, and build durable clinical infrastructure that improves affordability, quality outcomes, and member experience. This leader must be able to manage high-performing clinical teams, establishing a culture of clarity and accountability while also modernizing clinical operations in one of the most regulated managed care markets in the country. The HSD partners closely with the CEO, CMO, Quality, Finance, Operations, National Clinical Strategy, Optum partners, and New York State stakeholders to ensure clinical programs are compliant, effective, and positioned for growth. Scope of Accountability (NY-Specific) Care Management 2.0, State-Specific CM, HFS/NICU Long Term Services & Supports (LTSS) including MAP Clinical contributions to quality recovery (Tier movement) Regulatory readiness, contract adherence, and audit performance (DOH, OMIG, NCQA, IPRO) Clinical affordability initiatives (IP, ER, LTSS utilization) Clinical staffing oversight, productivity management, and workforce planning Clinical operating model design and execution Clinical technology evolution If you are a local to tri state region, you will have the flexibility to work remotely as you take on some tough challenges. Please note there is an expectation to travel once a week to the NY office.

Requirements

RN or equivalent clinical licensure (advanced)
10+ years in Medicaid or Duals managed care clinical leadership
Proven experience leading audits, CAPs, and regulatory remediation
Deep familiarity with NY Medicaid, LTSS, or other heavily regulated markets
Demonstrated ownership of statewide care management or UM programs

Nice To Haves

Experience launching or scaling integrated programs (e.g., MAP, FIDE, MLTC)
Experience leading modernization or transformation efforts (e.g., workflow redesign, technology adoption, AI enabled processes)
Demonstrated success building strong clinical leadership teams, improving engagement, and leading through change
Proven reputation as a clear, credible communicator with the ability to align diverse stakeholders around shared priorities
Proven history of translating strategy into execution under financial pressure

Responsibilities

Own end-to-end execution of care management and utilization management programs across all NY lines of business
Ensure consistent operational performance across CM 2.0, State-Specific CM, HFS/NICU, and LTSS
Translate NY-specific regulatory requirements into scalable workflows and controls
Support the advancement of technology into workflows for workflow efficiency and modernization
Lead health plan clinical readiness for state and federal audits
Own corrective action plans and sustained remediation following audits or findings
Maintain tight coordination with compliance, legal, and national clinical partners
Partner with Quality Director and the CMO to close priority quality gaps and improve tier placement
Drive clinical interventions tied to inpatient utilization, ER diversion, and LTSS trend management
Use data to prioritize interventions with measurable ROI
Build a strong, values‑driven clinical culture grounded in transparency, psychological safety, accountability, and continuous improvement
Establish clear communication rhythms across a large, distributed workforce to ensure teams understand priorities, decisions, and expectations
Translate complex regulatory and operational requirements into simple, actionable guidance for frontline and manager level leaders
Partner with national workforce planning for ongoing staffing evaluations, focusing on sustainable MAP and LTSS growth, maintenance of engagement in clinical programs, with aligned management of taffing models and monitoring productivity standards
Serve as NY’s operational clinical voice with Optum, national clinical teams, and state partners
Lead the adoption of innovative clinical workflows and operating models that improve productivity, member experience, and regulatory durability
Champion the thoughtful use of AI, automation, and analytics to modernize care management, assessment, documentation, and reporting processes
Balance state specific regulatory nuance with forward looking system and workflow design - modernizing how work gets done without compromising compliance