Director, Issue Management

Job title: Director, Issue Management

Company: UnitedHealth Group


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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.About the RoleThis position will have accountability for management, performance administration of multiple functions and processes across Payment Integrity Issue Management and Root Cause teams. The person will be responsible for driving issue resolution and root cause for highly complex clinical problems for Payer Operations. This role requires leading both clinician and non-clinical employees across multiple levels and multiple functions/departments across one or more business units. Responsibilities include achieving improved resolution times, reducing issue submissions, and partnering with operations to address root cause. The position includes overall accountability of project execution and performance improvement associated with the Issue Management teams. Individual will have direct accountability for operations both domestically & globally. Responsibilities include but are not limited to day-to-day operations management, oversight on escalated provider issues and development of resolution plan, manage leadership internal and external to organization, mitigating risks and issues to ensure successful delivery of plans, and developing new strategies for growth and conducting opportunity assessments. There will be accountability for financial and non-financial results, meet regularly with clients and achieve operational performance level agreements while monitoring compliance regulatory requirements. This role includes the development of presentations/materials, work queue prioritization, and daily production metrics to be accounted for including contingency plans when missed.Primary Responsibilities

• Responsible for the execution of the strategic plan in partnership with enterprise-wide leadership; this includes developing short and long term (1-3 year) business plans
• Responsible for leading direct and indirect teams across global locations with clinical and coding backgrounds
• Accountable leading team and successful achievement key service metrics (quality, resolution time, etc.)
• Provide coaching and leadership development to reports
• Identify & remove operational barriers
• Conduct deep dive program reviews with relevant internal and/or external stakeholders to identify opportunities for continuous improvement
• Drive continuous improvement related to productivity and efficiency of operational processes
• Establish and/or implement internal and/or external service level agreements in order to ensure ability to monitor and measure program performance (e.g., turnaround time; quality; effectiveness)
• Identify and/or secure resources (e.g., funding; staffing; system security; real estate and/or telecommuting requirements; hardware/software) required to implement programs
• Review, create, and/or maintain workflows to ensure they are up-to-date and operationally efficient
• Provide guidance, expertise, and/or assistance to internal and/or external partners (e.g., claims; call center; benefits; clinical) to ensure programs and strategies are implemented and maintained effectively
• Communicate with and help internal and/or external partners interpret contractual requirements in order to ensure effective problem solution and strategy implementation
• Provide input to internal and/or external stakeholders (e.g., sales; shared business partners; pre-service vendors; facilities) in order to drive effective business plan and sales strategy development
• Conduct regular meetings (e.g., Quality Business Reviews) 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)
• Develop corrective action plans to address and/or resolve relevant internal and/or external stakeholders’ concerns or issues regarding operational issues

Qualifications

• Bachelor’s Degree OR Associates degree in a relevant discipline (business management, project management, etc.) OR equivalent experience
• Experience in the healthcare industry
• Coding experience
• Intermediate experience with the Microsoft Office Suite (Word, PowerPoint, Excel, and Outlook)
• Proficiency in using advanced functions in Microsoft Excel such as filters, pivot tables, formulas, etc.
• Experience utilizing operational metrics, data/analytics, goals/objectives and dashboards to run, interpret, and drive business performance
• Ability to manage sensitive, escalated situations with internal and external customers
• Previous experience leading various Operational teams and functions
• Self-motivated and able to work with little direct supervision and drive results with disciplined follow though
• Experience managing budgets and/or business cases associated to projects and savings achievement
• Experience working with senior-level managers and executives
• Must demonstrate an ability to message, position, and present information for maximum customer impact and influence
• Highly collaborative style; experience developing, implementing and delivering on growth strategies
• Ability to establish credibility and build relationships at all levels

Assets

• Experience in client facing roles
• Coding or Nursing Certification/Degree

Careers with Optum. Here’s the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world’s large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life’s best work.SMAt 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.Please note you must currently be eligible to work and remain indefinitely without any restrictions in the country to which you are making an application. Proof will be required to support your application.Diversity creates a healthier atmosphere: Optum is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to gender, civil status, family status, sexual orientation, disability, religion, age, race, and membership of the Traveller community, or any other characteristic protected by law. Optum is a drug-free workplace. © 2025 Optum Services (Ireland) Limited. All rights reserved.

Expected salary:

Location: Dublin

Job date: Thu, 29 May 2025 22:18:13 GMT

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