Clinical Operations Director - Clinical AI - Remote

At United Healthcare, 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.

• 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.

• 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…