Job description


  • Entry level
  • No Education
  • Salary to negotiate
  • Eden Prairie


Position Description

No industry is moving faster than health care. And no organization is better positioned to lead health care forward.  We need attention to every detail with an eye for the points no one has considered. The rewards for performance are significant. You'll help improve the health of millions. And you'll do your life's best work.(sm)
The health care markets are evolving in many different ways and the role and impact of the Medicaid is becoming increasingly important as health plans and providers look for new ways to grow and manage risk. In particular, the ability to manage medical cost through care management interventions or network management strategies is critical to the success of these organizations.
Optum is seeking a Decisions Rules Director to provide expertise in the Medicaid market. This position is responsible for the consulting solutions in all areas of Medicaid managed care products including, but not limited to, TANF, CHIP, LTSS, , Duals Population, , and provider sponsored organizations taking on risk for some of the most complex Medicaid populations.
You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
Responsible for gathering business requirements, solution, design and testing of the decision rules for implementations.
Direct responsibility for the oversight, hands on participation and delivery of large scale Medicaid consulting projects/programs; large scale programs are defined as high cost, high complexity and/or high risk
Ensure utilization rate and billable revenues are attained annually
Facilitate development of business segment and enterprise level planning and program objective setting
Participate in program funding and prioritization decision processes
Provide strategic input to the development of program roadmap and timelines
Create a team oriented work climate that enables professional development and encourages creative solutions and strategies
Support the management of resources within programs
Support program communication plan and execution
Require that quality assurance methods are implemented within the program
Provide status updates and review of programs to senior leadership
Provide coaching and mentoring of project team with the goal of developing and retaining talent within the organization
Establish trusted partner relationships to expand the Payer Consulting footprint at designated clients
Work with client to lay out strategic roadmap for consulting solutions
Provide financial and data analysis to support ROI for project funding
Obtains high client satisfaction scores (90%)
Develop and maintain clients references

Required Qualifications
8+ years of extensive Medicaid experience within a consulting or payer related organization
3+ years of experience with ODM and FICO Blaze business rules engines
5+ years of experience implementing Medicaid Health Plans
5+ years of experience with Medicaid claims, EDI,  and Encounters
Experience implementing cost savings solutions using business rules engines with Claims, Clinical or Enrollment applications
5+ years of experience in Management of Business Requirements, Data Analysis, System Integrated Testing and User Acceptance Testing.
Ability to travel up to 80%
Preferred Qualifications:
Bachelor's degree
Ability to create and execute SQL reports
Knowledgeable in Medicaid Payer best practices
Excellent presentation, writing and negotiation skills
Experience with Agile Methodology
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care 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.(sm)
*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy
Diversity creates a healthier atmosphere: UnitedHealth Group is

About the company

Our mission is to help people live healthier lives and to help make the health system work better for everyone.

A Fortune 6 company, we're focused on helping people live healthier lives while making the health system work better for everyone. Here, we seek to empower people with the information, guidance and tools to make personal health choices. We work harder and we aim higher. We expect more from ourselves and each other. And, at the end of the day, we’re doing a lot of good for more than 85 million people worldwide.

Our biggest point of differentiation is our people - and the collective talent, energy, intelligence and drive our force of 188,000 individuals around the world bring to our mission every single day. So, how do we do it? With our every action, interaction and intention that demonstrates the five fundamental values that guide everything we do:

• Integrity
• Compassion
• Relationships
• Innovation
• Performance

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