Director Of Affordability And Solutions - Remote - Remote Eligible

Director Of Affordability And Solutions

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

The Director of Affordability and Solutions ensures that the individual client performance metrics and program expectations are being met on an on-going basis for all OptumHealth Care Solutions programs and products purchased. The DAS proactively identifies and communicates client level trends and opportunities to improve quality, efficiency and program effectiveness.

If you are located in Cincinnati, OH, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

1. Monitor key performance indicators for all client programs delivered, maintaining a client status indicator
2. For those where the program performance metrics are not being met, ensure corrective action plans are developed, implemented and communicated to appropriate stakeholders
3. For selected clients, perform annual comprehensive clinical analytical review
4. Evaluate variances to or achievement of committed metrics consistent with OptumHealth product definitions and performance guarantees
5. Evaluate client level medical cost and utilization trends
6. Identify program opportunities
7. Communicate recommendations with defined value to support client population needs
8. Attend client meetings as requested
9. Commonly for the purposes of delivering the OptumHealth value story as part of client level performance and outcomes reporting or finalist meetings
10. Provide assistance in preparing for all client and external audits. Represent OptumHealth Care Solutions during audits for all program / product questions, operational delivery enhancements, and future planned solutions to identified gaps
11. Post audit, contribute to the documentation of issue resolution steps and work with responsible teams to ensure steps are implemented
12. Support translation of client business requirements into the operational set up and delivery during the implementation phase
13. Post implementation, ensure at client level all products purchased are set up correctly and all referral feeds are working properly
14. Identify and translate client and / or book of business requirements into stable and scalable design solutions
15. Act as a clinical subject matter expert to products and operations staff for innovative client program design and development
16. Other responsibilities as assigned

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• RN licensure in the state of residence
• 5+ years in nursing
• 5+ years of experience in operational, problem solving, process development and consensus building roles in a direct or indirect managed care environment, including multi-functional departments
• Experience with OCM (Optum Clinical Manager)
• Clinical product operations experience in utilization management, case management, disease management or discharge planning or similar
• Healthcare industry experience
• Knowledge of clinical program design, implementation, management / monitoring
• Data analysis capabilities with strong drive to synthesize the story into an actionable set of recommendations
• Demonstrated ability to translate product and operational design and complex medical situations to non-clinical terms for client understanding
• Demonstrated ability to translate client business objectives and expectations to scalable sustainable solutions

Preferred Qualifications:

• 3+ years of external client facing or customer facing experience
• 3+ years proven analytics background (gathering data reports, analysis of data, identification of changes, creation of action steps based upon findings)

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary for this role will range from $110,200 to $188,800 annually based on full-time employment. We comply with all minimum wage laws as applicable.