Description

Optum 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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

This individual will report directly to the Optum Health Chief Risk Officer and serve as a key subject matter expert within the Optum Health Ireland VBC Office. This role will blend strategic leadership, compliance oversight, and technology enablement within the Risk Office. The Senior Director, Medical Record Optimization will also be responsible for educating team members and stakeholders on measurement principles and practices.

Careers with Optum offer flexible work arrangements and individuals who live and work in the Republic of Ireland will have the opportunity to split their monthly work hours between our Dublin or Letterkenny office and telecommuting from a home-based office in a hybrid work model.

Primary Responsibilities:

Strategic Oversight of Medical Record Systems

• Design and implement enterprise-wide strategies for optimizing electronic health record (EHR) systems
• Re-engineer existing retrospective chart review programs into a standardized, technology-enabled operating model
• Establish and manage the end-to-end process - including chart targeting, retrieval oversight, workflow integration, quality review, valuation, and reporting
• Develop and deploy a "retrieve once, use many" platform that enables multi-program utilization of retrieved medical records (e.g., for Risk Adjustment, Quality, and Clinical Programs)

Compliance and Regulatory Governance

• Ensure all medical record systems and workflows comply with HIPAA, CMS, Joint Commission, and other regulatory standards
• Design audit frameworks and internal controls to monitor compliance and mitigate risk

Operationalization & Execution

• Partner with analytics and product teams to optimize chart targeting logic, ensuring retrieval focuses on the highest-value and compliant records
• Oversee external retrieval partners, ensuring efficiency, hit-rate improvement, cost optimization, and SLA adherence
• Establish frameworks for program valuation and performance management, including cost-per-record, retrieval effectiveness, and incremental value yield
• Collaborate with HEDIS and Quality leaders to streamline abstraction and maximize reuse of existing medical records
• Partner with onshore Coding, QA, and Compliance teams to ensure accuracy, completeness, and audit readiness across all programs
• Innovate through technology, leveraging automation, OCR/NLP, and AI to improve record processing efficiency and clinical insight generation
• Lead pilots and proof-of-concepts using AI/LLMs responsibly to improve efficiency while maintaining explainability and compliance
• Manage a cross-functional team of program managers, analysts, and BI developers in Ireland, working closely with onshore SMEs
• Create dashboards and reporting to monitor key metrics such as retrieval rate, cost-per-record, reuse rate, automation rate, and QA pass rate
• Drive continuous improvement and build scalable governance for all medical record data workflows

You will 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 providing development for other roles you may be interested in.

Required Qualifications:

• Bachelor's degree in business, engineering, health informatics, data science, or a related discipline
• Proven solid experience in healthcare operations, health technology, clinical data management, or a regulated data-intensive environment
• Proven experience standardizing complex operational processes across multiple teams or business lines
• Demonstrated solid background in program/process design, performance improvement, and value measurement
• Proven experience leading cross-functional teams and vendor relationships across global or matrixed organizations
• Demonstrated familiarity with clinical or medical record data (EHRs, unstructured text, imaging, etc.) and its operational use in analytics or coding
• Demonstrated excellent communication and stakeholder management skills across technical, clinical, and executive domains
• Proven advanced proficiency in MS PowerPoint and Excel

Preferred Qualifications:

• Advanced degree (MBA, MS in Informatics, or similar) preferred
• Proven certifications in Lean, Six Sigma, or Project Management (PMP)
• Proven experience with U.S. healthcare operations, particularly Risk Adjustment, Quality (HEDIS/STARS), or value-based care models
• Demonstrated familiarity with OCR/NLP technologies, AI-assisted document processing, and related compliance frameworks
• Proven understanding of healthcare data standards (e.g., HL7 FHIR, C-CDA) and data governance principles
• Demonstrated solid quantitative and analytical skills; ability to interpret data trends and operational KPIs

Please note you must currently be eligible to work and remain indefinitely without any restrictions in the country to which you are making an application. Proof will be required to support your application.

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.

Diversity creates a healthier atmosphere: Optum is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to gender, civil status, family status, sexual orientation, disability, religion, age, race, and membership of the Traveller community, or any other characteristic protected by law. Optum is a drug-free workplace. © 2025 Optum Services (Ireland) Limited. All rights reserved.

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