Director Medicare Operations and Compliance for Government Programs - UHG - AmeriChoice, Phoenix, AZ

UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health.



AmeriChoice, a UnitedHealth Group company, is a recognized leader and innovator in providing managed health care solutions to its Medicaid membership.  With over a decade of growth and success we are poised for continued expansion of our services in this dynamic marketplace. Our commitment to this specialized market makes a genuine difference in thousands of lives. Join us, do rewarding work, and build a great career.

 

This position provides national support, management skills and utilization of internal and external resources to accomplish the goals and objectives that translate into efficient and compliant Medicare SNP plans for AmeriChoice.   Develops tactical business plans for Medicare including operational goals, performance targets, compliance targets, and implementation of best practices across markets. Organizes and leads the efforts of department managers to achieve effective and efficient coordination of all departments. Develops an organization structure, operational standards, and policies and procedures to meet the objectives of overall operations. Recruits and hires qualified staff and provides for their training and development. Sets performance expectations and goals, evaluates performance results, provides feedback to managers and administers appropriate rewards. Fosters a cohesive and supportive team environment. Prepares and is accountable for the Medicare Operations budget.  Maintains working knowledge of Medicare regulations, the managed care industry, the competitive environment, pertinent legislation, etc. Establishes and maintains a continuous liaison with federal and state officials, legislators, county government representatives, and municipal governing bodies to manage issues across CMS Regions as applicable to each AmeriChoice health plan. 


Adept at understanding complex concepts and situations presented by the business environment.
Quickly assesses complex problems and selects the appropriate solution. Possesses very strong consultative skills.
Influences much of the business through direction of teams.
Decisions made effect the profitability of the business segment.
Knows products sold in their market.
Clearly explains the difference between products.
Selects the correct product for the customer's situation.
Sees trends in products.
Possesses expert underwriting, financial and analytical skills.
Leads teams in any project related to the selling environment.
Gives directions and brings the project to fruition.
Develops work plans to effectively manage projects.
Translates business strategies into clear objectives.
Builds internal networks and consensus to shape decisions of upper management.
Builds and maintains positive, constructive working relationships with senior levels as well as internal and external customers.
Balances the big-picture concerns with day-to-day activities.
Links business operations and business plans to that of broader organization. Identifies critical high-payoff strategies.
Solid understanding of the company's mission, strategy, strengths and weaknesses Bachelor's degree or equivalent work experience.
Master's degree preferred.
Eight plus years experience in a managed care or health insurance industry desired.
Previous Medicare experience preferred.
Six plus years management experience in a managed care/insurance environment preferred.
Knowledge of HCFA regulations and standards.
Extensive understanding of goals, processes, procedures, jobs and dynamics of managed health care.
Ability to travel.

Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V