Health Plan COO, New York - Remote

Careers at UnitedHealth Group

We're creating opportunities in every corner of the health care marketplace to improve lives while we're building careers. At UnitedHealth Group, we support you with the latest tools, advanced training and the combined strength of high caliber co-workers who share your passion, your energy and your commitment to quality. Join us and start doing your life's best work. SM


Compassion. It's the starting point for health care providers like you and it's what drives us every day as we put our exceptional skills together with a real feeling of caring for others. This is a place where your impact goes beyond providing care one patient at a time. Because here, every day, you're also providing leadership and contributing in ways that can affect millions for years to come. Ready for a new path? Learn more, and start doing your life's best work. SM

Our teams are helping people from around the world. We can bring out your best as you put your listening, analytical and problem solving skills to work in a setting that is geared to helping improve lives and enhance health care for millions. Here, you'll discover a wealth of pathways for professional growth within Customer Service, Billing, Claims, Enrollment & Eligibility and across our global economy. Join us and find out why this is the place to do your life's best work. SM

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)

The Chief Operating Officer is responsible for management of all business operations and ensuring contractual compliance for the Medicaid, CHIP and DSNP lines of business. This role provides subject matter expertise in project management, project scope definition, risk identification, project methodology, resource allocation and strategic direction.

The COO is also responsible for the design, coordination, and completion of operational improvement projects across various functional areas within UnitedHealthcare. The COO will review the departments performance and effect change as needed to improve service, simplify the workflow, and assure compliance with regulatory requirements. They will effectively lead a team that is focused on making a difference for our members and our state partners.

The COO is also responsible for management and administration of multiple functions and general business operations, provider services and member services. This position manages daily operations of multiple levels of staff and multiple functions/departments across UnitedHealthcare.

If you are located in NY, CT, or NJ, you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:
  • Collaborates with CEO and Executive Team on strategy and business planning to achieve business goals and maximize financial and customer performance. Sets business direction, develops, and implements and oversees operational models to meet business requirements
  • Ensures all operational activities conform to contract compliance for Medicaid, CHIP and DSNP lines of business. Understands state and federal legal and contractual regulations and requirements; translate requirements into operational metrics and protocols
  • Supports internal and external audits and accreditation activities
  • Owns business analysis and successful implementation of new contractual requirements
  • Meets with state customers and regulators to collaborate on program improvements and customer program goals.
  • Leads team of direct report operations staff plus, matrix responsibility for functional teams including but not limited to Billing and Enrollment, Claims, Encounter Reporting, Payment Integrity, Member Call Center, Provider Call Center, Provider Data Operations, IT
  • Manages staff responsible for timely and accurate regulatory reporting (non-financial) to NY Department of Health (DOH)
  • Manages staff responsible for delegated Subcontractor oversight, and onboarding and monitoring of vendors/subcontractors
  • Develops collaborative relationships with and confirms business partners can execute day-to-day responsibility for operations (member services center, enrollment, technology, etc.)
  • Serve as the link between health plan requirements and national support functions, including requests for program changes, implementation, training, etc., balancing local customization with national scale and efficiency
  • Drive collaboration between health plan and shared service partners to use audit and reporting metrics to ensure performance against contractual and regulatory requirements
  • Supports health plan leadership team to implement new clinical, quality and affordability initiatives. This includes heavy emphasis on business analysis as well as defining data strategy, data acquisition and data analysis needs to evaluate strategies and operationalize new programs
  • Identifies and remediates performance issues and assist department leads in resolving complex technical, operational and organizational problems
  • Identifies and implements performance opportunities including those to improve Member experience and Provider experience, efficiency and accuracy. Owns end-to-end process improvement: definition of need, project plans, status updates, reporting and achieving results.
  • Provides governance on Provider network strategy and development
  • Informs and advises management regarding State's current trends, and problems and activities to facilitate both short- and long-range strategic plans to improve operational performance and enhance growth
  • Limited travel (10-15%) prior to the COVID-19 pandemic

Leadership Expectations: Demonstrate Leadership and Cultural Values
  • Deliver value to members by optimizing the member experience and maximizing member growth and retention
  • Lead and influence Health Plan employees by fostering teamwork and collaboration, and driving employee engagement and leveraging diversity and inclusion
  • Lead change and innovation by demonstrating emotional resilience, managing change by proactively communicating the case for change and promoting a culture that thrives on change
  • Drive sound and disciplined decisions that drive action while effectively using financial knowledge and data to manage the business
  • Drive high-quality execution and operational excellence by communicating clear directions and expectations
  • Experience within healthcare operations, clinical services, network, and products and benefits
  • Customer-focused; proven ability to handle complex situations, resolve conflicts and issues effectively. Sensitive to how people and the organization function
  • Demonstrated ability to translate strategic objectives into action plans and lead / motivate teams to execute plans effectively; flexibility to adapt and change direction as needed

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:
  • Minimum of a Bachelor's degree
  • 5+ years of related managed care experience
  • 5+ years of leadership experience
  • Knowledge of and experience related to publicly funded government health care programs (e.g., Medicaid, Medicare or State health care programs for the uninsured)
  • Technical and financial understanding of health care operations
  • Ability to advise IT resources related to enterprise platform initiatives; provides direction on platform migration
  • Experience in matrix environment
  • Working knowledge of relevant federal and state regulations and requirements
  • In depth understanding of challenges that face health plans and health care in general
  • Ability to stay apprised of ongoing changes that impact health plan operations

Preferred Qualifications:
  • Master's degree
  • Exceptional leadership skills and operational management expertise
  • Excellent communication skills
  • Solid analytical and problem-solving skills
  • Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance

UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.

Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.(sm)

Connecticut Residents Only: The salary range for Connecticut residents is $103,300 to $250,200. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.

*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.

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