17 days old

Executive Director - South Carolina - RELOCATION AVAILABLE - Columbia or Telecommute within Commutable Distance to Columbia Office

Columbia, SC 29201 Work Remotely
  • Job Code

The Health Plan Executive Director (ED) directs the strategic development, growth and operations of the South Carolina health plan. This role has overall accountability to meet revenue, membership and operating income objectives, develop key provider affiliations, establish an influential relationship with the state, direct and effectively develop strategic goals into specific business plans, and create a successful, collaborative team of people to achieve these goals.

This role is critical to serving as the 'Account Manager' for the State of South Carolina relationship, managing all aspects of profit-and-loss, driving overall performance, leading strategic planning and managing a state-based operation through a matrix team. Working closely with the United HealthCare Community and State Leadership Team, the Health Plan ED will become familiar with the established vision, mission and strategies of the organization and will build on these to effectively define, articulate and address the current and future needs and priorities of the local market. They will effectively lead a team that is focused on making a difference for our members and our state partners.

This role is expected to lead cross functional teams to deliver on revenue, membership, quality scores and outcomes, operating income objectives, develop key provider relationships, establish an influential relationship with the state, direct and effectively develop strategic goals into specific business plans, and create a successful, collaborative team of people to achieve these goals.
The role will also need to collaborate closely with the Medicaid health plans in the market to meet state and federal policy objectives and requirements.

If you are located within commutable distance from Columbia, SC, you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:


  • P&L accountability for 25,000 members and growing
  • Work with Optum at Home on risk-adjusted rates (HCC and RAF) to maximize revenue via coding
  • Work with M&R and Optum financial teams around trends, reserving, tracking, affordability, chargebacks, and remediation

Strategy & Growth:

  • Direct the strategic development, growth and operations of the health plan in providing innovative care by developing and executing market-specific strategies to drive sustainable and profitable growth
  • Effectively develops strategic goals and turns those goals into specific operating and business plans that are executed in partnership with intersegments (i.e. Optum, Network, etc.)
  • Ensure commitment/support for health plan strategies and programs from internal and external stakeholders
  • Foster state/local relationships (e.g. communication, engagement & identification) to identify and drive potential merger and acquisition opportunities to grow the Medicare/Medicaid business
  • Lead the strategic direction and decision-making for RFP bid processes as required, in order to drive business growth
  • Lead the government sector in industry reform and business growth
  • Identify and/or pursue potential business opportunities with new and/or existing
  • Develop network contracting strategies, including the composition of the network and use of VBC arrangements
  • Identify market-specific and/or regional priorities and determine the appropriate strategic approaches that will drive business growth and differentiate in the marketplace
  • Deliver value to members by optimizing the member experience and maximizing member growth and retention

Relationship Building:

  • Collaborates with the state partners to build long-lasting transparent and trusting relationships
  • Build strong relationships with the State that drives the organization to deliver industry-leading customer service and satisfaction through the Net Promoter Score
  • Represents UnitedHealthcare at external events and organizations; interacts with Community & State leaders
  • Collaborates with network and other UHC lines of business in the State and surrounding markets to advance overall strategic objectives
  • Collaborates with the Medicaid health plans to drive positive outcomes for members and providers
  • Build, develop, improve, influence and expand relationships with key government sector customer groups, providers/provider networks and government/regulatory stakeholders within the market
  • Drive strong brand recognition and reputation within the market and community to positioning health plan for procurements and re-procurements

Operational Effectiveness:

  • Drive oversight of, and collaboration with, the key shared services partners (e.g. Ops, UCS, UHN, OptumRx, M&R)
  • Drive oversight of OAH as a delegated entity that receives capitation from UHC
  • Drive high-quality execution and operational excellence by communicating clear directions and expectations
  • Develops operational protocols to verify effectiveness and compliance that exceed the expectations and commitments made to the State partners
  • Drive competitive advantage and differentiation in the marketplace by strategically gathering and analyzing market intelligence data to understand our place in the market, and proactively act on industry opportunities and threats, determine how to position our business for continued success.
  • Understand and manage multiple levers of health plan profitability (e.g. rate advocacy, member retention, utilization management, Star performance & Medicaid Quality)
  • Partner with Optum At Home to reviews medical expense drivers and creates plans to reduce the waste and increase the affordability of our programs
  • Play an active role in implementing innovation solutions by challenging the status quo and encouraging others to do so
  • Develops and executes operational imperatives to support collaboration with Medicaid health plans and the State, including necessary data exchange; resolution of issues in joint operating committees; and analysis and reporting
  • Manage execution by delegating work to maximize productivity, exceed goals and improve performance

Performance & Satisfaction:

  • Drive sound and disciplined decisions that drive action while effectively using financial knowledge and data to manage the business
  • Provides leadership to and is accountable for the customer satisfaction, provider satisfaction, financial and operational performance of the Health Plan
  • Understand and manage multiple levels of profitability
  • Analyze budget performance and variances throughout the fiscal year, and recommend and/or make necessary adjustments and corrections
  • Clinical outcomes/quality
  • Lead the clinical and quality efforts to produce successful STARs results and improved clinical outcomes in partnership with Optum At Home
  • Exercise executive leadership over quality, clinical models and outcomes, including the Model of Care, transitions of care, effective interventions related to persistent super-utilizers and high-risk/high-need members
  • Exercise executive leadership over the collaborative efforts with the Medicaid health plans around clinical data sharing, case conferences, collaboration, authorizations, and other strategies to produce high-quality outcomes in Medicaid and Medicare for members


  • Lead and influence functional partners by fostering collaborative partnerships
  • Influence and negotiate effectively to arrive at win-win solutions
  • Communicate and present effectively, listen actively and attentively to others, and convey genuine interest
  • 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
  • Effectively represent the market in national and regional discussions/processes within UHC, including business planning and regular leadership meetings

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.



Posted: 2020-10-06 Expires: 2020-11-05

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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Executive Director - South Carolina - RELOCATION AVAILABLE - Columbia or Telecommute within Commutable Distance to Columbia Office

UnitedHealth Group
Columbia, SC 29201

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