Vice President, Network Operations - Telecommute in TX

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

Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life's best work.(sm)

Times are exciting here as we continue to grow and expand our markets. We are now seeking an experienced VP, Network Operations at our location in San Antonio, TX. This is a supervisory role responsible for the oversight of our various operational functions within the network operations team. In this role you will be responsible for ensuring compliance with all company goals, directives and objectives, and accountable for ensuring a high level of performance towards achieving outcome targets. You will be responsible to drive improvements in cost, quality and performance. You'll have the opportunity to play an important role in the strategic development of WellMed's continued expansion.

If you are located within Texas, you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities
  • Establishes and maintains appropriate systems and scorecards for measuring necessary aspects of operational management
  • Plans, develops and implements policy for configuration and operational departments to meet agreed organizational performance plans and expansion within agreed budgets and timeframes
  • Collaborate in development of automation as needed and identify process improvements necessary to improve efficiencies within operational units
  • Collaborates with senior level business, medical leaders on company-wide initiatives related to medical costs, payment integrity, payer partner strategy, and UM initiatives
  • Interfaces with medical management partners related to process and performance, CMS compliance, monthly reporting and other items as needed
  • Provides supervision, development and mentoring, evaluation and management of staff
  • Provides continual process improvement including all Quality, HEDIS and Focus on Care processes and/or services
  • Creating corrective action plans for metrics off track
  • Performs all other related duties 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:
  • Undergraduate degree in Business, Finance, Health Administration or related field (stellar candidates without an undergraduate degree who have 15+ years of relevant professional experience may also be considered)
  • 10+ years of progressive operational experience in medical management or claims
  • 5+ years of direct supervisory experience
  • Experience evaluating and determining appropriate course of action to meet business-client needs
  • Demonstrated experience driving process improvements and driving results in a dynamic, matrixed environment with a high degree of organizational change, growth and ambiguity
  • Intermediate or higher proficiency working in MS Excel, Word, PowerPoint, and Outlook

Preferred Qualifications:
  • Bachelor's Degree or Master's Degree in related field
  • Experience in a field that specializes in HEDIS/Stars improvement
  • Passion for and commitment to a consumer and client driven culture
  • Solid history of building relationships, quickly gaining credibility, partnering with business leaders and exhibiting executive presence
  • Excellent planning and execution skills; meticulous and methodical; detail oriented with a demonstrated ability to dive deep and ask the right questions
  • Ability to be a problem solver and influencer, and successfully deliver projects in high pressure, deadline-oriented environment
  • Demonstrated self-starter with solid planning, organization, analytical and problem-solving skills
  • Ability to effectively communicate (both written and verbal) in a professional manner
  • 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

As a Fortune 5 company with over 750,000 people all pulling in the same direction, we're used to setting the pace for change.

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies now require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles require full COVID-19 vaccination as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 550,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)

WellMed was founded in 1990 with a vision of being a physician-led company that could change the face of healthcare delivery for seniors. Through the WellMed Care Model, we specialize in helping our patients stay healthy by providing the care they need from doctors who care about them. We partner with multiple Medicare Advantage health plans in Texas and Florida and look forward to continuing growth.

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

Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.

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

Job Keywords: Vice President, Network Operations, STARS, HEDIS, Medicare, provider relations, risk adjustment, data validation, quality, contracting, CAHPS, HOS, Humana, Aetna, BCBS, strategy, management consulting, business development, contracting, product, operations, provider relations, Telecommute, Telecommuting, Telecommuter, Work From Home, Work At Home, Remote