VP Health Services / Health Services Director - Phoenix, AZ Hybrid
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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 equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. The Vice President of Health Services (also known as the Health Services Director) is responsible for overseeing the care of a highly complex population eligible for both Arizona Medicaid and Medicare. This population includes members enrolled in four distinct health plans: Dual Special Needs Medicare, general Medicaid, individuals with intellectual and developmental disabilities, and elderly or physically disabled individuals requiring long-term care. The role requires comprehensive management of federal and Arizona state AHCCCS-mandated health service programs such as maternal child health, EPSDT, high-risk/high-needs care management, medical services, prior authorization, and special programs. Additionally, the position entails significant regulatory reporting and oversight duties. The Health Services Director reports directly to the Chief Medical Officer (CMO) and serves as a key regulatory 'Key Staff' position required by AHCCCS and DDD contracts, referred to as the Medical Management Manager. This role requires physical residency in Arizona and credentials as a Registered Nurse (RN), physician, or physician's assistant in good standing with their respective state licensing boards. The VP must have sufficient local staff with appropriate physical and behavioral health expertise to support whole-person health and ensure compliance with all AHCCCS MM contractual and policy requirements. Responsibilities include managing all Medical Management (MM) requirements outlined in AHCCCS and DDD policies, Arizona State regulations, rules, and contracts. This involves reviewing state policies and rules (e.g., AMPM; AdSS; AAC; CFRs; Health Plan Contracts) to ensure program compliance. The Health Services Director provides leadership for functional areas such as High-Risk Care Management, Health Risk Assessments (HRAs), ED diversion/hold programs, Healthy First Steps (Maternal Child Health), Adult and Juvenile Judicial Reach-In Programs, among other state-mandated programs. The position oversees multiple Clinical Operational departments responsible for these regulatory programs, coordinating care and services to optimize resource utilization. This leader supervises at least three direct reports who manage further teams, totaling approximately 70 health plan staff members. Responsibilities include ensuring adherence to compliance standards, maintaining processes that monitor member access to appropriate medical, behavioral health, dental, and pharmacy services. Additionally, this leader identifies and executes strategies to address business challenges across functions. The primary focus is on monitoring clinical activities for compliance while advising leadership on opportunities for improvement that impact medical expenses.
