DSNP Executive Director, New Jersey and Rhode Island - Remote in New Jersey and Rhode Island

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.

Primary 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

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:

• 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 

Preferred Qualifications:

• 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

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). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $159,300 to $273,200 annually based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.  

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

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