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American Health Network (AHN), part of Optum, is seeking an experienced leader to take on the role of Sr. Director of Value-Based Care (VBC) and Risk Performance. This key position is responsible for managing and optimizing AHN performance across both government and commercial risk contracts, with a focus on value-based care models. The ideal candidate will develop data-driven strategies and collaborate closely with clinical operations, risk-bearing entities (RBEs), and other stakeholders to ensure the effective implementation of VBC programs.
You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Preference for remote in Indiana and Ohio
Primary Responsibilities:
Government and Commercial Risk Contracts:
Possess a deep understanding of risk contracts, including terms, processes, and financial impact
Prioritize high-value contracts and design programs that enhance performance and maximize financial outcomes
Develop data-driven performance action plans, focusing on such as the Risk Adjustment Factor (RAF) payout cycle and quality payout cycles
Apply deep knowledge – such as supplemental data feeds, RAF payout cycles, and Quality payout cycles – to ensure operational excellence. This includes understanding when and how coding, data submissions, and payments occur, and how to optimize for accurate and timely reimbursements
Develop and implement data-driven action plans to continuously improve VBC performance, using metrics and analytics to drive decision-making and optimize results
Collaborative Operations Management:
Work closely with Operations, Clinics, Finance and RBEs to align goals and streamline care programs
Collaborate with providers to enhance performance in risk and quality metrics, particularly within population health management
Support payer contracting efforts by ensuring alignment with VBC strategies and the risk-bearing entity’s goals
Management of AHN ACO:
Oversee the management and performance of the AHN Accountable Care Organization (ACO), ensuring that ACO targets are met and opportunities for improvement are identified and acted upon
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 industry experience in a related field, with a proven track record in VBC and risk management
Health plan or managed care experience
Solid Medicare and clinical program experience including clinical program delivery and performance improvement techniques
In-depth knowledge of value-based care models, healthcare reimbursement methodologies, and regulatory requirements
Proven solid analytical skills with the ability to interpret complex healthcare data and use insights to drive strategic decision-making
Proven track record of driving results, influencing decision-making, and fostering collaboration in a matrixed organizational structure
Preferred Qualifications:
In-depth knowledge of value-based contracts, from initiation through implementation
C-Suite communication, collaboration, presentation, and negotiation skills
Proven track record of developing and implementing successful value-based care initiatives with a healthcare system or payer organization
*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, Washington, Washington, D.C., Maryland Residents Only: The salary range for this role is $104,700 to $190,400 annually. 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.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
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.
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.
UnitedHealth Group
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