UnitedHealth Group Director of Data Management Operations in Dublin, Ireland
As the largest health insurance payor in the United States, and as one of the largest healthcare services providers, UnitedHealth Group provides a professional culture where you're empowered and encouraged to exceed the expectations of our members, while making a tangible impact on the healthcare ecosystem.
Join us and start doing your life's best work.(sm) This position plays a pivotal role in maintaining operations excellence pertaining to programs that manage, help to qualify, predict, and assess risk of the populations served by our insured business segments and by our clients. Specifically, the Director of Data Management Operations will lead a global team responsible for managing the processes that extract, transform, validate, and finally submit claims, encounter, and supporting clinical information to regulatory agencies that administer the Risk Adjustment programs for Medicare Advantage and Commercial clients. This leader will help to develop innovative data management strategies that will assist in meeting planned regulatory changes in data submission filtering logic, adapt to future changes that may occur as a result of further health care reform, and validate excellence in data accuracy and quality. Primary Responsibilities: Lead efforts to enhance data abstraction / filtering processes to meet regulatory timelines Develop strategies to reduce reliance on cumbersome processes, streamline abstraction and submission Drive efforts to reduce operations cost for Risk Adjustment data submission Support internal and external audits, including preparing strategies to meet the needs of Risk Adjustment Data Validation (RADV) testing Partner with Technology organization to evaluate platform enhancements, ongoing platform maintenance, and triage technology investments / needs Coordinate teams in multiple locations to drive “round the clock” service model Work with leadership and stakeholders from other related functions (ex. - Claims) to understand strategic programs, platform changes, etc.
that may drive needs for process change in Risk Adjustment submissions Champion initiatives and capital proposals with executive leadership that will push submissions solutions forward Evaluate Risk Adjustment submissions service levels in market and UHG's competitive positioning Stay abreast of regulatory changes impacting Risk Adjustment and data submissions / validation processes Drive awareness of regulatory changes impacting abstraction, submission processes through global Risk Adjustment business and to upstream functions Coordinate with House Calls, Charting, and other upstream data collection functions to describe data requirements, advocate for better solutions Establish and/or implement internal and/or external service level agreements in order to ensure ability to monitor and measure technology-enabled program performance (e.g., turnaround time; quality; effectiveness) Identify and/or secure resources (e.g., funding; staffing; system security; real estate and/or telecommuting requirements; hardware / software) required to implement programs Review, create, and/or maintain workflows to ensure they are up-to-date and operationally efficient Monitor technology enabled operational performance against internal and/or external service level agreements Drive understanding of the business environment and requirements among applicable stakeholders (e.g., own team, IT partners, business partners) Demonstrate understanding of the needs and priorities of external stakeholder groups, as applicable (e.g., health plans, providers, employers, government) Ensure alignment of IT projects and deliverables with key business metrics (e.g., KPIs) Ensure appropriate risk assessment and mitigation planning for IT projects Monitor/manage vendor performance to ensure compliance with contract terms/conditions and deliverables, as applicable Translate technical terminology into common business language to ensure understanding by all stakeholders Demonstrate understanding of applicable laws/regulations/requirements (e.g., HIPAA, SOX, ARRA, regulatory, PHI, PII) Develop in-depth knowledge risk adjustment and quality coding policies to ensure system implementations align with overall compliance requirements Demonstrate understanding of financial processes/tools to support IT plans and execution (e.g., capital project funding, cost / benefit analysis, Internal Operating Income [IOI], other financial metrics) Conduct end-to-end testing of applicable processes, tools, procedures, and systems platforms to validate adherence to RFP / contract requirements Required Qualifications: BA / BS in relevant field (economics, business, finance, accounting, engineering, etc.) Proven leadership experience at upper management level Confident communication and presentation style Prior experience with data validation / audit processes Familiarity with data management, data quality initiatives Strong work experience in related industry (healthcare, insurance, finance) Significant experience in related job capacity (data quality, data management, reporting) Demonstrated people management / team leadership experience Experience driving new strategies and solutions to market Up to 10%, including international travel (must have current passport) Preferred Qualifications: Familiarity with US healthcare system and Risk Adjustment as administered in concert with Medicare Advantage products or healthcare exchanges products governed by the Affordable Care Act P&L ownership Understanding of software development life cycle and Agile framework Post-graduate degree in relevant field of study (ex. JD, MBA, PhD, MA or MS Finance / Accounting, Computer Science, Engineering) Experience setting up new business units / divisions Global experience Multiple experiences across landscape (consulting, insurance, financial operations) Careers with Optum.
Here's the idea.
We built an entire organization around one giant objective; make the health system work better for everyone.
So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve.
Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential.
For you, that means working on high performance teams against sophisticated challenges that matter.
Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm) 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. Job Keywords: Director, Management, Risk Adjustment Submissions, Dublin, Ireland, Travel dfa291ef-a476-4e47-9087-6c76f641f61d
Director of Data Management Operations Ireland-Dublin 723250