Director, Population Health Payer Programs

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.

In this role, you will be responsible for providing direction and guidance on clinical quality improvement and management programs, including accreditation. You will act as the direct interface between Optum and affiliated health plan networks to support their operations and quality improvement performance. This position includes continuous education, support, training, and troubleshooting for physicians and their staff. You will conduct clinical quality audits and may be responsible for NCQA requirements, focusing on the reporting and analysis of member care quality and the development of plans and programs to support continuous quality improvement using tools like HEDIS.

Primary Responsibilities:

• Health Plan Quality Improvement Relationship Management
• Serve as the single point of contact for Optum California Quality Improvement/Risk Adjustment, ensuring accountability and responsiveness to health plan quality improvement needs
• Monitor quality and risk performance of affiliated health plans, identify areas of underperformance, and work with leadership to develop action plans for improvement in key metrics
• Collaborate with internal Optum QI teams to ensure accurate and timely reporting of health plan data and work closely with health plan QI teams to implement and monitor action plans
• Escalate and intervene in QI health plan issues when necessary, collaborating with teams to resolve issues effectively
• Provide leadership and direction to multiple layers of management and senior-level professional staff
• Develop and execute strategies for the quality function that impact large business units or multiple markets/sites
• Make product, service, or process decisions that affect multiple functions or customer accounts
• Drive continuous quality improvement across the health plan networks, ensuring a high standard of care and performance
• Program Oversight with Health Plan Relationships
• Lead operational execution of population health programs, ensuring alignment with value-based care contracts and financial goals
• Drive optimization of care management workflows, provider engagement tools, and performance tracking systems
• Monitor key performance indicators (KPIs) to measure the success of population health initiatives, including utilization, cost, and quality outcomes
• Oversee implementation of innovative care delivery models such as remote patient monitoring, digital health, and community partnerships
• Stakeholder Engagement & Collaboration
• Foster strong relationships with healthcare providers, payers, and community organizations to enhance care delivery and coordination
• Collaborate with regional and national Optum leaders to align strategies and share best practices
• Engage with provider networks, health plans, and government agencies to enhance partnerships and advocacy effort

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:

• 5+ years of clinical experience
• 3+ years of clinical quality management experience
• 3+ years of experience working in managed care or the insurance industry
• Proven ability to lead with strategic direction, develop tactical plans, and drive performance to meet targets
• Solid presentation skills, with experience delivering formal presentations to senior leadership
• Proven expertise in managing large-scale population health programs and value-based care models
• Solid knowledge of healthcare regulations, risk stratification, and quality performance metrics (HEDIS, STAR ratings, Medicare Advantage, Medicaid)
• Exceptional ability to collaborate with executive leadership, providers, and cross-functional teams

Preferred Qualifications:

• Experience in California with a deep understanding of regional healthcare regulations and payer/provider landscapes
• Background in integrated delivery systems, accountable care organizations (ACOs), or large medical groups

The salary range for this role is $106,800 to $194,200 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

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