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The Health Services Director (HSD) serves as the senior operational clinical leader for the UnitedHealthcare Community Plan of New York, accountable for the execution, compliance, performance, and continuous improvement of all care management and utilization management programs across Medicaid, Essential Plan, and Medicaid Advantage Plus (MAP).
This role is designed for a proven leader who can operate at scale in a highly regulated environment, translate strategy into operational results, and build durable clinical infrastructure that improves affordability, quality outcomes, and member experience. This leader must be able to manage high-performing clinical teams, establishing a culture of clarity and accountability while also modernizing clinical operations in one of the most regulated managed care markets in the country.
The HSD partners closely with the CEO, CMO, Quality, Finance, Operations, National Clinical Strategy, Optum partners, and New York State stakeholders to ensure clinical programs are compliant, effective, and positioned for growth.
Scope of Accountability (NY-Specific)
Care Management 2.0, State-Specific CM, HFS/NICU
Long Term Services & Supports (LTSS) including MAP
Clinical contributions to quality recovery (Tier movement)
Clinical affordability initiatives (IP, ER, LTSS utilization)
Clinical staffing oversight, productivity management, and workforce planning
Clinical operating model design and execution
Clinical technology evolution
If you are a local to tri state region, you will have the flexibility to work remotely* as you take on some tough challenges. Please note there is an expectation to travel once a week to the NY office.
Primary Responsibilities:
Clinical Operations & Execution
Own end-to-end execution of care management and utilization management programs across all NY lines of business
Ensure consistent operational performance across CM 2.0, State-Specific CM, HFS/NICU, and LTSS
Translate NY-specific regulatory requirements into scalable workflows and controls
Support the advancement of technology into workflows for workflow efficiency and modernization
Regulatory & Audit Leadership
Lead health plan clinical readiness for state and federal audits
Own corrective action plans and sustained remediation following audits or findings
Maintain tight coordination with compliance, legal, and national clinical partners
Quality & Affordability Partnership
Partner with Quality Director and the CMO to close priority quality gaps and improve tier placement
Drive clinical interventions tied to inpatient utilization, ER diversion, and LTSS trend management
Use data to prioritize interventions with measurable ROI
People & Operating Model Leadership
Build a strong, values-driven clinical culture grounded in transparency, psychological safety, accountability, and continuous improvement
Establish clear communication rhythms across a large, distributed workforce to ensure teams understand priorities, decisions, and expectations
Translate complex regulatory and operational requirements into simple, actionable guidance for frontline and manager level leaders
Partner with national workforce planning for ongoing staffing evaluations, focusing on sustainable MAP and LTSS growth, maintenance of engagement in clinical programs, with aligned management of taffing models and monitoring productivity standards
Innovation & Enterprise Leadership
Serve as NY's operational clinical voice with Optum, national clinical teams, and state partners
Lead the adoption of innovative clinical workflows and operating models that improve productivity, member experience, and regulatory durability
Champion the thoughtful use of AI, automation, and analytics to modernize care management, assessment, documentation, and reporting processes
Balance state specific regulatory nuance with forward looking system and workflow design - modernizing how work gets done without compromising compliance
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:
RN or equivalent clinical licensure (advanced)
10+ years in Medicaid or Duals managed care clinical leadership
Proven experience leading audits, CAPs, and regulatory remediation
Deep familiarity with NY Medicaid, LTSS, or other heavily regulated markets
Demonstrated ownership of statewide care management or UM programs
Preferred Qualifications:
Experience launching or scaling integrated programs (e.g., MAP, FIDE, MLTC)
Experience leading modernization or transformation efforts (e.g., workflow redesign, technology adoption, AI enabled processes)
Demonstrated success building strong clinical leadership teams, improving engagement, and leading through change
Proven reputation as a clear, credible communicator with the ability to align diverse stakeholders around shared priorities
Proven history of translating strategy into execution under financial pressure
*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 $134,600 to $230,800 annually based on full-time employment. We comply with all minimum wage laws as applicable.
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.
Optum, part of the UnitedHealth Group family of businesses, 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 h...
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