Sr. Director Clinical Strategy and Operations - Remote

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 Director, Clinical Strategy & Affordability is a senior clinical leader accountable for the design, execution, and oversight of market-wide clinical affordability and operational strategies for the Virginia C&S Health Plan, with primary focus on Virginia Cardinal Care (Medicaid).

This role owns end-to-end clinical affordability strategy, translates state contract and regulatory requirements into executable clinical and operational plans, and provides strategic leadership across multiple clinical operations functions. The Director leads teams responsible for provider performance audits, clinical administrative operations, and clinical infrastructure that supports frontline Care Coordination, ensuring regulatory compliance, operational excellence, and sustained medical cost containment while protecting quality and access.

The role serves as a key advisor to health plan executive leadership and partners closely with Medical Directors, Finance, Network, Quality, Compliance, and Analytics to drive integrated, data-informed clinical strategy.

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

Market-Level Clinical Strategy & Affordability Leadership

• Own and execute the Virginia health plan's clinical affordability strategy, aligning clinical focused initiatives with Cardinal Care contract requirements, quality standards, and organizational goals
• Develop and implement market-wide clinical strategies to address utilization trends, provider performance variation, avoidable cost drivers, and care delivery inefficiencies
• Translate complex clinical, financial, and regulatory data into clear strategic recommendations and executable operating plans
• Establish measurable objectives, performance indicators, and governance structures to track progress and ensure accountability for affordability initiatives

Provider Performance Oversight & Contract Compliance

• Provide executive oversight of the Provider Performance Audit program required under the Virginia Cardinal Care contract
• Ensure audit strategy, methodologies, workflows, and reporting meet state, CMS, and contractual requirements
• Partner with Provider Relations, Network Management, and Compliance to address audit findings, corrective action plans, and provider performance improvement efforts
• Analyze audit outcomes and performance trends to inform broader clinical strategy, provider engagement approaches, and system-level improvements

Clinical Operations & Infrastructure Leadership

• Direct clinical operations functions that support affordability, compliance, and frontline care delivery, including:
  • Provider performance audit teams
  • Clinical administrative operations supporting Care Coordinators
• Ensure clinical administrative infrastructure reduces administrative burden, improves documentation quality, and enables Care Coordinators to focus on direct member care and outcomes
• Set strategic direction, operational priorities, and performance expectations across teams, ensuring alignment with health plan objectives
• Drive continuous improvement in clinical workflows, operational efficiency, and cross-functional collaboration

Executive Partnership & Cross-Functional Leadership

• Serve as a senior clinical advisor to the Virginia CEO, CFO, and health plan leadership on affordability, clinical operations, and contract-driven requirements
• Influence strategy across a matrixed organization, partnering with Finance, Med Econ, Network, Quality, and Compliance to drive integrated solutions
• Represent the clinical organization in state readiness activities, audits, and regulatory engagements as needed
• Prepare and deliver executive-level communications, updates, and recommendations to leadership and governance forums

Talent Development & Organizational Leadership

• Lead and develop high-performing clinical leaders and professional staff, fostering accountability, growth, and succession readiness
• Establish a culture of clinical excellence, continuous improvement, and disciplined execution
• Mentor emerging leaders and ensure clinical operations teams are equipped to meet evolving regulatory and business demands

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:

• Active clinical license (RN, NP, PA, MD/DO, LCSW, or equivalent)
• 10+ years of progressive leadership experience in Medicaid, managed care, Medicare Advantage, or health plan clinical operations
• Demonstrated success leading clinical strategy, affordability initiatives, and operational execution at the market or enterprise level
• Deep understanding of Medicaid managed care, state contract requirements, provider performance oversight, and regulatory compliance
• Proven ability to lead through influence across complex, matrixed organizations

• Driver's License and access to a reliable transportation

Preferred Qualifications:

• Experience with Virginia Medicaid / Cardinal Care, Medicare Advantage, DSNP, or comparable Medicaid programs
• Experience overseeing provider audits, utilization management, care management, or quality improvement functions
• Solid executive communication, analytical, and decision-making skills

Key Competencies:

• Clinical and financial integration
• Strategic leadership and execution
• Market-level operational accountability
• Regulatory and contract compliance
• Provider performance management
• Executive presence and influence
• Talent development and culture building
• Owns market-wide clinical strategy, not just execution

*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.

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.