Job title: PPCV Associate Director Business Operations – Remote
Company: CPS Solutions
Job description: Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.The Associate Director will serve as client-facing lead for operational delivery functions for the pre-pay and Post Pay claims review service for multiple Commercial Clients (5+). The AD will closely partner with Operations Managers, Team Leads, Clinical, Non-Clinical resources, Business Analysts and Matrix Partners. Persons will be responsible for generating approximately $50-$400M in financial savings for Commercial clients in Fraud, Waste, and Error recoveries. This includes indirectly leading staff across multiple levels of staff and multiple functions/departments across one or more business units. Responsibilities include achieving SG&A cost goals, Client service level agreements and reducing unit costs. This includes overall accountability of project execution and performance improvement for a client specific Value Stream process. Individuals will have indirect accountability for large operations both domestically & globally. Responsibilities include day-to-day site operations, manage leadership internal and external to organization, accountable for financial and non-financial results (budgets and actuals), meet regularly with clients and meet operational performance level agreements and compliance regulatory requirements.You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.Primary Responsibilities:
- Manage Inventory, SLAs, productivity, through capacity analysis planning and quality control
- As client growth and organizational demand dictates, ADs will also lead project and relationship management for the implementation of one or more large, multi-year contracts, with coordination and quality assurance for all services delivered as well as ongoing optimization opportunity identification and development
- Identify and manage system issues, and ensuring data integrity, security controls and process adherence
- Work with matrix partners to manage client contract obligations and deliverables
- Achieve savings, revenue and IOI targets by effectively planning staffing and staff responsibilities as well as identifying efficiency opportunities – both technical and process driven
- Provide account management and partnership with sales to ensure that the appropriate processes are in place and proper follow-up with the client is occurring for operational delivery
- Drive favorable algorithm outcomes by partnering with Research & Development to provide policy expertise which will drive and optimize savings and revenue
- Ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance
- Identify & remove operational barriers. Conduct deep dive program reviews with relevant internal and/or external stakeholders to identify opportunities for continuous improvement
- Partner with offshore operations to tightly integrate business practices and deliver services at a more affordable rate, both internally and with our Matrix business partners
- Identify and/or secure resources (e.g., funding; staffing; system security; real estate and/or telecommuting requirements; hardware/software) required to implement programs
- Conduct regular meetings (e.g., External Clients, R&D, Operations) with relevant internal and/or external stakeholders to review and discuss updates and outstanding issues (e.g., project implementation readiness; compliance and/or quality audit results; out-of-compliance issues; staffing issues)
- Monitor and/or report on-going compliance and related outcomes (e.g., claim denials; complaints; clinical metrics) to relevant internal and/or external stakeholders (e.g., regulatory agencies; customers; vendors)
- Ensure that business continuity/emergency response plans are reviewed and tested regularly, up-to-date, and can be readily executed
- Demonstrate understanding of budgeting and forecasting tools and implement cost controls to manage costs
- Analyze budget performance and variances throughout the fiscal year, and recommend and/or make necessary adjustments and corrections
- Work with relevant internal partners (e.g., Finance; Underwriting) to identify resource requirements and/or create budgets and forecasts
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:
- 3+ years of experience developing and managing operational metrics
- 3+ years of experience working within a health plan and/or managed care business operation
- 3+ years of operational management experience within FWAE space
- 2+ years of experience with workforce management and staff planning
- 2+ years of experience indirectly leading a global team
- 2+ years of client facing experience and ongoing operational support
- Ability to travel 10%
Preferred Qualifications:
- Certified Coder in ICD 10 and ICD 9 or RN/LPN
- 1+ years in leadership role with experience in management of supervisors and leaders
- 1+ years of experience during new client implementation
- Experience in fraud detection, analytic methodologies, payment policies and provider contracts
- Proven ability to produce superior results in a financial performance-oriented environment
- Solid leadership and strategic planning skills within a matrix environment
- Excellent communication, presentation and negotiation skills
- Solid interpersonal skills, ability to work with all levels of management across all functional areas
*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy.Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $89,900 to $160,600 annually based on full-time employment. We comply with all minimum wage laws as applicable.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.UnitedHealth Group 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.UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.
Expected salary: $89900 – 160600 per year
Location: Eden Prairie, MN
Job date: Thu, 30 Oct 2025 01:21:31 GMT
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