Job title: Vice President of Clinical Strategy and Performance – Remote in US
Company: CPS Solutions
Job description: At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.The Vice President of Clinical Strategy and Performance leads the clinical strategies for the Individual and Family Plans (IFP) business, focusing on affordability, regulatory adherence, compliance, and value-based care.This role is accountable for driving clinical strategy with a focus on expanding and optimizing value-based care arrangements with providers including clinical model design and clinical performance evaluation for capitated/delegated and accountable care organization arrangements.The role includes developing and executing the IFP affordability strategy with a focus on IFP-specific affordability initiatives that drive value for members and result in more affordable care. This individual will leverage data on utilization and cost trends and new state, federal, and competitor policies to inform the design of targeted national and market-specific affordability initiatives including the development of new clinical programs, remediation of specific markets, network actions, and program integrity initiatives. This individual will act as a key clinical business partner on network development and sculpting, risk adjustment activities, provider incentive programs, and program integrity initiatives.The VP of Clinical Strategy and Performance must be able to draw upon a matrixed team to drive complex business processes throughout and across the organization and will be accountable to clinical performance and affordability targets. This role will report to the Chief Medical Officer & VP Individual & Specialty and will partner closely with the United Clinical Services Value Creation team, Enterprise Clinical Services, and United Health Network as well as the IFP Clinical Operations, Clinical Quality, Strategy, Product and Operations teams. This position has a significant role in distinguishing our IFP business in the marketplace by driving clinical strategy for value-based arrangements and supporting high quality and affordable care while ensuring compliance with state and federal regulations, laws and mandates.Results are critical to this leader’s success, as is a personal alignment with UHC’s mission to help people live healthier lives and the core belief that an organization can manage cost and deliver quality and value to its customers. IFP is a rapidly growing business that serves over 1.4 million members across 30 states.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:Clinical Strategy:
- Oversee IFP clinical and identify opportunities to enhance the model and improve quality and cost outcomes based on clinical key performance indicators
- Review national and market-specific utilization and cost data monthly with healthcare economics to identify emerging trends and opportunities for new clinical programs and affordability initiatives
- Co-lead regular clinical business reviews for senior enterprise and exchange executive leaders.
- Partner with healthcare economics team to present data on clinical, pharmacy and BH utilization and cost trends and the results of national and market-specific affordability initiatives to address these trends
- Represent IFP in QBRs, JOCs and Business Reviews with Optum clinical partners including Enterprise Clinical Services, Optum Behavioral Health, Specialty Guidance Program, Cancer Guidance Program, Musculoskeletal to discuss their performance on their KPIs
Clinical oversight of IFP’s VBC arrangements:IFP VBC Strategy
- Partner with UnitedHealth Network to identify providers and health systems that have the skills and interest to engage in IFP’s value-based contracting strategy
- Partner with multiple internal constituents and external provider organizations to implement population health capabilities and KPI formation for value-based care arrangements
Capitated/Delegated Arrangements
- Division of Medical Responsibilities (Clinical model design). Clinical evaluation of delegation capabilities of potential new capitated/delegated partners including utilization management, care management, quality/NCQA, and out-of-network management capabilities
- Clinical performance evaluation including oversight of authorization volumes and decisioning in collaboration with IFP Strategy team
- Affordability by partnering with capitated/delegated entities to identify affordability opportunities
- Accountable Care Organization (ACO) Arrangements
- Oversee clinical performance of ACOs provider partners in collaboration with national ACO team, network, finance and healthcare economics
- Partner with ACO provider partners and UHC national ACO team to identify opportunities to improve accurate diagnosis and coding, affordability, and clinical quality and experience for IFP members
Affordability:
- Oversee IFP affordability, with an emphasis on identification and execution of IFP-specific initiatives that drive more affordable care while improving members’ experience and clinical outcomes
- Develop and execute national and market-specific affordability initiatives informed by medical and behavioral health utilization and cost trends, new clinical evidence and guidelines, competitor analysis, and state or federal policy changes
- Partner with the IFP, E&I and Government Programs pharmacy teams to develop national and market-specific pharmacy affordability initiatives based on new clinical evidence/national guidelines, competitor analysis, and/or new state or federal policies
- Partner with UCS Value Creation teams and E&I affordability leaders to align IFP affordability with E&I affordability including evaluating and adopting new E&I affordability initiatives for IFP where possible
- Monitor and drive performance of the IFP business to IFP affordability targets in collaboration with the E&I affordability team
Monitor performance of each market and develop targeted affordability initiatives using rapid cycle improvement methodology to achieve optimal resultsRegulatory Adherence and Compliance
- Oversee the team responsible for ensuring compliance with federal regulations and state-specific laws and clinical mandates
- Conduct audits and create corrective action plans to maintain adherence to all relevant regulations and mandates
Culture and Strategy
- Lead with integrity and accountability, modeling UnitedHealth Group’s values and vision
- Collaborate with legal, clinical and compliance partners to foster a culture that meets all legal, regulatory and ethical requirements
- Maintain professional affiliations and pursue ongoing professional development to stay current with health care administration trends
- Work effectively as team member in highly matrixed leadership environment while promoting team engagement and collaboration across the organization
- Foster a safe, healthy, positive, and productive work environment and builds positive working relationships within the team and across partners and key stakeholders
- Work hand-in-hand with IFP’s VP of Clinical Transformation & Operations to ensure adherence and alignment to enterprise strategies and programs
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 progressive management experience
- Bachelor Degree or equivalent related experience
- Leadership experience in a managed care company or organization serving government entities
- Experience developing and launching clinical models and utilization management initiatives for Commercial, Medicaid, or Individual Exchange populations
- Proven ability to work in a matrix management environment and build effective partnerships
- Proven solid leadership and motivational skills, with a focus on disciplined, fact-based decision-making
- Proven ability to balance multiple accountabilities and organizational change
- Ability to use strategic thinking and business acumen to align recommendations with clinical operations objectives
- Ability to quickly gain credibility and influence when partnering with key stakeholders, business and clinical leaders
- Attention to detail, particularly when analyzing large data sets to support decision making
- Proven exceptional relationship skills across diverse functions including United Clinical Services, United Health Network, Operations, Optum Enterprise Clinical Services, and Optum Behavioral Health
- Up to 25% travel to MN or provider partnership
Preferred Qualifications:
- Clinical and Financial/Business Operations experience
- Master’s Degree or equivalent related experience – healthcare related degree is preferred
*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter PolicyPay 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 $156,400 to $268,000 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:
Location: Minnetonka, MN
Job date: Mon, 10 Nov 2025 06:01:00 GMT
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