Clinical Operations Director - Clinical AI - Remote

Job description

Improve the lives of others while Caring. Connecting. Growing together.

Job Description - Clinical Operations Director - Clinical AI - Remote )

Clinical Operations Director - Clinical AI - 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 Clinical Operations Director – Clinical AI will serve as a clinical strategy and solution enablement leader responsible for reviewing, indexing, and helping advance scalable AI solutions and support tools across inpatient, medical claims review, and reconsideration/appeals operations. This role will work cross collaboratively with product, technology enablement, technology, clinical operations, regulatory and key business stakeholders to translate clinical needs into prioritized AI opportunities, support ideators through the AIRB process, and provide clinical insight to AIRB governance discussions as initiatives are brought forward.

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

Primary Responsibilities:

Review, index, and maintain visibility to emerging clinical AI ideas, use cases, and support tools across inpatient, MCR, regulatory and appeals to identify opportunities for scale, reuse, and enterprise alignment

Partner cross-functionally with product, technology enablement, technology teams, clinical operations, and key stakeholders to solution practical, compliant, and scalable AI-enabled workflows that support operational modernization

Understand AIRB intake, review, and prioritization pathways and support business ideators in preparing AI initiatives for review, including clarifying clinical value, operational impact, risk considerations, dependencies, and prioritization rationale

Serve as a clinical subject matter resource for AIRB board discussions, providing clinical context and answering questions related to utilization management, inpatient review, MCR, appeals, regulatory considerations, and member/provider impact

Develop executive-ready summaries, recommendations, and progress updates that communicate AI opportunity areas, prioritization status, solution readiness, and anticipated business impact

Resolve highly complex business problems that impact multiple areas of the organization

Develop executive-level updates and reports

Develop and execute measurable department-level business and affordability goals

Think creatively and curiously about business opportunities and communicate openly with leadership on strategies to operationalize change

Collect and review data to evaluate financial outcomes and present solutions to senior leaders to drive efficiencies

Aid in the development of operational budgets

Up to 10% travel

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, PA, NP, Pharmacist, MD, or other active clinical licensure with solid understanding of utilization management

5+ years of experience in a health plan, provider organization, payer-provider environment, or clinical operations setting supporting technology-enabled transformation

Experience evaluating AI, automation, analytics, clinical decision support, or workflow modernization opportunities for relevance, scalability, risk, and impact

Ability to translate clinical business problems into AI use cases, solution concepts, acceptance criteria, or measurable business outcomes

Working knowledge of responsible AI principles, governance expectations, model risk, privacy, compliance, and regulatory impacts

Ability to support AI intake and prioritization, including business rationale, value statement, workflow impact, dependencies, and AIRB readiness

5+ years of professional experience partnering across product, strategy planning, technology enablement, technology delivery, clinical, operational, compliance, data, and senior stakeholder groups

Excellent communication skills, including ability to synthesize complex AI and clinical concepts into executive-level recommendations

Preferred Qualifications:

Degree, certification, or formal training in health informatics, clinical informatics, data science, analytics, or a related field

Industry certification or training in AI, data analytics, agile delivery, process improvement, product management, project management, or change management

Experience supporting AI governance, AIRB submissions, responsible AI reviews, or enterprise intake/prioritization forums

Experience supporting CBA requirements, including value statements, impact assumptions, rationale, and documentation for prioritization, funding, and executive decision-making

Experience with generative AI, machine learning, predictive analytics, automation, clinical decision support, or AI-enabled workflow design

Ability to assess AI solution readiness, including intended use, clinical oversight, workflow integration, human-in-the-loop controls, measurement, and change management

Skills You Will Develop:

Advance clinical AI strategy and solution intake practices across a highly matrixed enterprise

Evaluate AI use cases for clinical relevance, scalability, operational impact, and governance readiness

Manage emerging priorities, stakeholder needs, and solution development in a fast-paced environment

*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 - $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.

UnitedHealth Group is committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities. If you need special assistance or accommodation for any part of the application process, please call to be connected to Recruitment Services. Recruitment Services hours of operation are 7 a.m. to 7 p.m. CT, Monday through Friday.

UnitedHealth Group is a registered service mark of UnitedHealth Group, Inc. The UnitedHealth Group name with the dimensional logo, as well as the dimensional logo alone, are both service marks for the UnitedHealth Group, Inc.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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Worksite address

minnetonka, MN, 55345, US

Who can apply

Review the original listing for work authorization, qualifications and employer requirements.