3 Unitedhealth Group jobs in Houston

At Houston Methodist, the Director Managed Care Contracting position is responsible for the development, negotiation, maintenance and payer relations of the Houston Methodist (HM) contracts for reimbursement of services billed through managed care companies and serves as a technical expert for management and operations staff of specific HM facility and Physician Organization contracts for reimbursement of services billed through managed care. The managed care payers include commercial payers, separate transplant contracts, Medicare Advantage, Medicaid Health Maintenance Organizations (HMOs), International, behavioral health, worker's compensation, student insurance, bundled payment contracts, quality metric bonus program and risk contracts.
The Director position responsibilities include overseeing the activities of the department staff, ensuring quality, productivity, functional excellence and efficiency to accomplish strategic and operational objectives. In addition, this position is accountable for employee engagement, adequate staffing levels, budget development and compliance, staffing decisions such as hiring and terminating employment, coaching and counseling employees on work related performance, and developing and implementing policies and procedures to ensure a safe and effective work environment. This position also ensures training, monitoring and operations initiatives are implemented which secure compliance with ethical and legal business practices and accreditation/regulatory/government regulations.
**PEOPLE ESSENTIAL FUNCTIONS**
+ Directs, develops and implements strategic and operational/high level projects and processes either through independent/highly autonomous work or through the facilitation of work teams to enable the effective and efficient completion of objectives.
+ Oversees management of and ensures development for staff to meet overall objectives in terms of quality, service and cost effectiveness. Provides timely guidance and feedback to help others strengthen specific knowledge/skill areas needed to accomplish a task or solve a problem. Directs management responsibilities of selection, scheduling, supervision, retention, and evaluation of employees.
+ Meets or exceeds threshold goal for department turnover and/or system metrics on employee engagement indicators.
+ Provides leadership and communication to maintain a competent and engaged employee group by conducting regular department meetings to review policies and procedures and operational matters, rounding on all employees, completing performance appraisals, conducting new hire feedback sessions, coaching/corrective counseling, and providing recognition/commendations to achieve desired outcomes.
+ Identifies opportunities and takes action to build strategic relationships between one's area and other areas, teams, departments, and units to achieve business goals. Drives the promotion of teamwork within and between departments; participates and/or leads and facilitates department process improvements as needed.
+ Develops and maintains ongoing relationships with payers, physicians, and hospital staff.
**SERVICE ESSENTIAL FUNCTIONS**
+ Oversees department operations, designated projects, schedules and activities as needed to ensure that goals or objectives are accomplished within the prescribed time frame. Sets priorities and functional standards, giving direction to staff as necessary to ensure the best possible delivery of service and high customer/patient satisfaction.
+ Drives department service standards and activities to impact department and/or system score for patient/customer-based satisfaction, through role modeling and fostering accountability. Serves and actively participates on various entity committees as a voice for the department.
+ Provides assistance to finance, accounting, operations teams regarding interpretation of contracts and applied billing.
+ Utilizes a thorough understanding of managed care operations to maximize reimbursement.
**QUALITY/SAFETY ESSENTIAL FUNCTIONS**
+ Ensures a safe and effective working environment; monitors and/or revises the department safety plan and/or any specific accreditation/regulatory required safety guidelines. Responsible for staff maintenance of credentials and competencies, per accrediting/ licensing agency and/or department guidelines as applicable.
+ Employs a proactive approach in the optimization of safe outcomes and information systems by monitoring and improving the department workflow and enhancing operations, using peer-to-peer accountability and identifying solutions via collaboration. Implements process improvements utilizing tools such as lean principles. Role models situational awareness, using teachable moments to improve safety.
+ Responsible for employee compliance to policies and procedures and performs associated actions upon non-compliance (i.e., licensure/certification compliance, focal point review requirements, disaster plan, in-services, influenza immunization, wage and hour, standard hours, timely termination submission, timely timecard approval, etc.).
+ Analyzes contract proposals including but not limited to analysis of per diems, carve outs, new procedures, new drugs. Analyzes proposals which include capitation reimbursement, Medicare resource-based revenue value scale (RBRVS) values, current procedural terminology (CPT) coding, discounts, carve outs, new procedures, new drugs, diagnosis related groups (DRGs) ambulatory payment classifications (APC), etc.
+ Directs the contracting process and all documentation related to contract pricing, rate structures, addendums, and language requirements.
+ Analyzes and manages payer quality metric bonus and risk programs in conjunction with internal partners.
**FINANCE ESSENTIAL FUNCTIONS**
+ Develops and manages department operational and capital budgets, approvals, and ongoing maintenance of the department(s), ensuring operation in a cost-effective manner. Proactively identifies and plans for capital needs related to current equipment and future department projects. Ensures staffing plans and schedules meet department needs that reflect understanding of the importance of cost-effectiveness.
+ Creates department strategies to achieve financial target and staffing needs, through optimizing productivity, supply/resource efficiency, minimizing incidental overtime and overtime percentage, and other areas according to department specifications.
+ Pursues revenue enhancement opportunities through the contracting process both at the time of renewal, and through regular review of existing contract specifications. Oversees and manages new payer negotiations and renegotiations in conjunction with other Managed Care leaders and executives and system executive team and legal department.
**GROWTH/INNOVATION ESSENTIAL FUNCTIONS**
+ Identifies and implements innovative solutions for practice or workflow changes to improve department, entity or system operations by leading unit projects and/or other department/ system-directed activities. Proactively leads task forces and committees. May represent HM at assigned community or professional organization meetings.
+ Drives change initiatives, maintaining effectiveness when experiencing major changes in work responsibilities or environment; adjusts effectively to work within new work structures, processes, requirements or cultures. Partners effectively with stakeholders as appropriate.
+ Ensures own career discussions occur with appropriate management. Completes and updates My Development Plan (MDP) on an on-going basis. Conducts conversations with staff on their development and MDP.
+ Actively participates and contributes to the managed care strategic planning process and decision making on traditional and innovative payment models and creating the optimal course that incorporates fee-for-service and value-based designs.
+ Partners with hospital clinical performance executives in creating performance measurements for new care models to support meeting performance targets.
This job description is not intended to be all-inclusive; the employee will also perform other reasonably related business/job duties as assigned. Houston Methodist reserves the right to revise job duties and responsibilities as the need arises.
**EDUCATION**
+ Bachelor's degree in business administration, healthcare administration, finance, nursing or a related field required
+ Master's or Juris Doctor (JD) degree preferred
**WORK EXPERIENCE**
+ Five years experience in a complex healthcare environment to include provider, payer, consulting, technology or related specialty and two years people management experience.
**LICENSES AND CERTIFICATIONS - REQUIRED**
+ N/A
**KNOWLEDGE, SKILLS, AND ABILITIES**
+ Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations
+ Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially about activities impacting patient or employee safety or security
+ Demonstrates the ability to interact with others in a way that gives them confidence in one's intentions and those of the organization
+ Ability to use appropriate interpersonal styles and techniques to gain acceptance of ideas or plans; modifying one's own behavior to accommodate tasks, situations and individuals involved
+ Demonstrates leadership qualities and critical thinking through self-direction initiative and effective interpersonal skills and oral/written communication skills
+ Ability to identify and understand issues, problems and opportunities, comparing data from different sources to draw conclusions; using effective approaches for choosing a course of action or developing appropriate solutions; taking action that is consistent with available facts, constraints and probable consequences
+ Extensive knowledge of regulatory and accreditation agency requirements that impact department; stays abreast of industry changes
+ Demonstrates highly effective communication skills-strong written communications and platform presentation abilities
+ Ability to work effectively in a fast-paced environment
+ Demonstrates flexibility and adaptability in the workplace
+ Capable of leading teams/facilitating groups, building consensus and garnering highest confidence in professionalism and work product by senior leadership
+ Ability to work under pressure and balance many competing priorities; highly responsive and solution/action oriented
+ Proficiency in spreadsheet, word processing, and presentation software
+ Maintains a positive and supportive attitude and demeanor
+ Professional handling of exposure to confidential/sensitive information
+ Understanding of local, State and Federal regulations related to health care as well as the ability to research new regulations
+ Understanding of payer policy and procedures and notification internally of any significant changes to these policies
+ Knowledge of acute care contracts, financial modeling techniques and managed care contracting, contract pricing, language requirements, rates and schedules, health care coding systems
+ Strong negotiation and relationship building skills
**SUPPLEMENTAL REQUIREMENTS**
**WORK ATTIRE**
+ Uniform No
+ Scrubs No
+ Business professional Yes
+ Other (department approved) No
**ON-CALL***
_*Note that employees may be required to be on-call during emergencies (ie. DIsaster, Severe Weather Events, etc) regardless of selection below._
+ On Call* Yes
**TRAVEL***
_**Travel specifications may vary by department**_
+ May require travel within the Houston Metropolitan area Yes
+ May require travel outside Houston Metropolitan area Yes
**Company Profile:**
Houston Methodist is one of the nation's leading health systems and academic medical centers. Houston Methodist consists of eight hospitals: Houston Methodist Hospital, its flagship academic hospital in the heart of the Texas Medical Center, and seven community hospitals throughout the greater Houston area. Houston Methodist also includes an academic institute, a comprehensive residency program, a global business division, numerous physician practices and several free-standing emergency rooms and outpatient facilities. Overall, Houston Methodist employs more than 27,000 employees and is supported by a wide variety of business functions that operate at the system level to help enable clinical departments to provide high quality patient care.
Houston Methodist is an Equal Opportunity Employer.

**JOB DESCRIPTION**
**Job Summary**
Analyzes complex business problems and issues using data from internal and external sources to provide insight to decision-makers. Identifies and interprets trends and patterns in datasets to locate influences. Constructs forecasts, recommendations and strategic/tactical plans based on business data and market knowledge. Creates specifications for reports and analysis based on business needs and required or available data elements. Collaborates with clients to modify or tailor existing analysis or reports to meet their specific needs. May participate in management reviews, including presenting and interpreting analysis results, summarizing conclusions, and recommending a course of action. This is a general role in which employees work with multiple types of business data. May be internal operations-focused or external client-focused.
**KNOWLEDGE/SKILLS/ABILITIES**
+ Elicit requirements using interviews, document analysis, and requirements workshops, business process descriptions, use cases, business analysis, task and workflow analysis.
+ Interpret customer business needs and translate them into application and operational requirements
+ Communicate and collaborate with external and internal customers to analyze and transform needs, goals and transforming in to functional requirements and delivering the appropriate artifacts as needed.
+ Work with operational leaders within the business to provide recommendations on opportunities for process improvements, medical cost savings or revenue enhancements.
+ Create Business Requirements Documents, Test Plans, Requirements Traceability Matrix, User Training materials and other related documentations.
+ Actively participates in all stages of project development including research, design, programming, testing and implementation to ensures the released product meets the intended functional and operational requirements.
**JOB QUALIFICATIONS**
**Required Education**
Bachelor's Degree or equivalent combination of education and experience
**Required Experience**
+ 5-7 years of business analysis experience,
+ 6+ years managed care experience.
+ Demonstrates proficiency in a variety of concepts, practices, and procedures applicable to job-related subject areas.
**Preferred Education**
Bachelor's Degree or equivalent combination of education and experience
**Preferred Experience**
+ 3-5 years of formal training in Project Management
+ Experience working with complex, often highly technical teams
**Preferred License, Certification, Association**
Certified Business Analysis Professional (CBAP), Certification from International Institute of Business Analysis preferred
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $77,969 - $128,519 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.