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 optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together

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)
• Regulatory readiness, contract adherence, and audit performance (DOH, OMIG, NCQA, IPRO)
• 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.