Director of Medical Management – Telecommute

UnitedHealth Group
March 26, 2021
Houston, TX
Job Type


UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm)

This position will report to the Senior Vice President of Utilization Management and will be responsible for helping drive best-in-class Utilization Management for UnitedHealthcare Clinical Services. The Director will work across the enterprise to help advance the modernization of utilization management, implement strategic process improvements, as well as provide analytical evaluation of appropriateness and efficiency of medical necessity. Additionally, this role will serve as an integral strategic partner for ongoing monitoring and improvements of the use of health care services, procedures, and facilities under the provisions of UnitedHealthcare. The UCS Medical Management Director will work with leaders across the enterprise to evaluate and help build the value proposition focusing on, but not limited to inpatient care management and prior authorization. The role will drive execution with Optum Enterprise Clinical Services as well as Optum MBM in an effort to reduce denials, improve member care, NPS and provider abrasion. The Director of Medical Management will require a strategic mindset with the ability to handle multiple priorities as well as the ability to articulate and represent both UHC and Optum’s strategy to executive leaders across the enterprise and external partners.

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. 

Primary Responsibilities:

  • Comprehensive analysis of prospective, concurrent, and retrospective review
  • Responsible for developing and executing the clinical strategy and programs to maximize health care quality
  • Analyzes the company’s health care claims data, clinical experience and customer feedback to identify opportunities for improvements and future programs
  • Accountable for post-deployment measurement of results
  • Development and execution of national clinical strategies and programs, clinical operations, and clinically integrated networks
  • Demonstrate the ability to envision creative, workable solutions
  • Quantitative analysis and evaluation of data sets and/or development of research methods to evaluate a problem and recommend data driven solutions
  • Financial modeling to calculate the costs and returns of the programs
  • Qualitative analysis and strategic problem solving
  • Articulate and represent both UHC and Optum’s strategy to executive leaders across the enterprise and external partners
  • Communicate with executives in decision-making, program management, and initiative implementation
  • Improves current processes and coordinates organizational procedures for optimized efficiency and productivity
  • Build and develop relationships across teams to ensure effective feedback loops and that deliverables are met
  • Advises leadership on improvement opportunities regarding medical expense programs and clinical activities that impact medical expense
  • Utilization review, risk management, and quality assurance of medical programs in order to ensure the judicious use of the facility's resources and high-quality care

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:

  • 5+ years of managed care experience
  • Extensive record of performance, by meeting and exceeding operational goals in health care quality and cost management
  • Proven success in change management and innovation
  • Proficiency in working in a matrix environment
  • Strategic thinking with proven ability to communicate a vision and drive results
  • Data analysis and interpretation skills
  • Ability to focus on key metrics
  • Demonstrated ability to make strategic, operational and administrative decisions in response to emerging conditions and environmental circumstances
  • Proven ability to drive, lead and communicate change effectively in a fast-paced environment and be adaptable within the changing environment
  • Ability to provide recommendations and insight regarding improvements to internal and external processes
  • Ability to manage programs and projects in a strategic and professional manner
  • Ability to manage and support organizational change and help assist individuals through the transition
  • Strong ability to communicate effectively and efficiently (both verbal and written) at multiple levels of large, complex organizations
  • Work seamlessly with internal and external teams
  • Motivate and influence others at all levels within the organization
  • Demonstrated ability in systems thinking and enterprise insight to solve complex business problems and strong analytical skills with ability to drive transformational, consumer - centric change and manage long-term programs
  • If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders

Preferred Qualifications:

  • Advanced degree in healthcare 

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 7 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans wherever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that’s second to none. This is no small opportunity. It's where you can do your life's best work.(sm)

Colorado Residents Only: The salary range for Colorado residents is $110,200 to $211,700. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary,  UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Job Keywords: Director of Medical Management, Managed Care, UHC, UnitedHealth Care, UHG, UnitedHealth Group, Telecommute, Telecommuting, Telecommuter, Remote, Work from Home, Houston, TX, Texas, Phoenix, AZ, Arizona, Los Angeles, CA, California, Tampa, FL, Florida, Chicago, IL, Illinois, New York, NY, New York

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