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We have modest goals: Improve the lives of others. Change the landscape of health care forever. Leave the world a better place than we found it. Such aspirations tend to attract a certain type of person. Crazy talented. Compassionate. Driven. To these individuals, we offer the global reach, resources and can-do culture of a Fortune 5 company. We provide an environment where you’re empowered to be your best. We encourage you to take risks and in return, offer a world of rewards and benefits for performance. Exceeding your limits is an exceptional start to your life's best work.SM


Just like you, we are driven by a set of fundamental principles that are guiding our way forward. Our values of integrity, compassion, relationships, innovation, and performance serve as a foundation to transform health care. Are you in? Learn more about your future at UnitedHealth Group at careers.unitedhealthgroup.com


Job Category:

Medical and Clinical Operations



Approximate Salary:

Not Specified

Position Type:

Full Time

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Enterprise Senior Medical Director - OptumCare

UHG - Minnesota, US

Posted: 10/20/2018

If you want to achieve more in your mission of health care, you have to be really smart about the business of health care. Challenge yourself, your peers and our industry by shaping what health care looks like and doing your life’s best work.(sm)
Enterprise Clinical Performance is charged with effectively designing, implementing, monitoring, and executing on clinical affordability programs and projects chartered with improving quality of care and achieving best in class clinical outcomes for our patients while reducing overall costs across providers within OptumCare. Enterprise Clinical Performance provides support to all markets served by OptumCare.
The OptumCare Enterprise Senior Medical Director will report to the Chief Clinical Performance Officer for OptumCare and will be responsible for providing strategic direction, development and execution on a model of care focused on population health, affordability, and quality and risk adjustment.  Candidate should be well versed in all lines of business (Commercial, Medicare and Medicaid) and have familiarity with care across the continuum of ages.
Candidate should be particularly versed in UM/CM/DM, Transitions of Care, Social determinants of health, risk adjustment, quality and End of Life Care programs. Candidate should have strong fundamentals in the practicality of delivery health care daily at the front lines, and how large scale enterprise programs, analytics, and capabilities can improve that care.
The role will be partnered with other Senior Medical Directors and together, with the support of the OptumCare team, will drive results. The role will not have any direct reports initially, but will be responsible for driving large projects, initiatives and managing through influence broadly.
Primary Responsibilities:
  • The Senior National Medical Director must be a deep subject matter expert who can drive execution and change through collaboration and relationships. The primary responsibilities include providing long-term planning and oversight assuring activities are appropriately integrated into strategic direction, as well as the mission and values of the company. This also involves selection and expansion of best practices while simultaneously striving for standardization and driving performance
  • Given the complex nature of OptumCare, the ability to achieve goals through a combination of direct and indirect influence will be critical
  • Lead through influence the Medical, Financial, and operational leadership of varying businesses and their corresponding hierarchies across the country with expectations to grow over time
  • Direct the delivery of extremely complex business solutions within the Enterprise Clinical Performance team and across multiple cross-matrixed teams
  • Provide leadership and direction in lowering the cost of care
  • Take full accountability for patient outcomes and financial results
  • Assist in driving results with the OptumCare Care Delivery Organizations
  • Coordinate inter-Care Delivery organization discussions to leverage knowledge and learning
  • Interface with Healthcare Economics teams to size, review and prioritize opportunities
  • Analyze and convey a deep understanding of data insights and use of standard benchmarks
  • Support overall regional and corporate goals to ensure continued growth and profitability
  • Participate in new market expansions
  • Align with national standards and medical expectations as they relate to care management and utilization management
  • Provide medical leadership for the Clinical Performance portfolio chartered with improving the quality of care and achieving best in class clinical outcomes for our patients while reducing overall costs across providers within OptumCare
  • Encourage building strong collaborative relationships with leadership and medical management resources in the care delivery organizations and key partners throughout the organization
  • Promote understanding of clinical best practices, market trends and customer needs related to care delivery, medical management and clinical affordability
  • Promote an environment of understanding of the market nuances to drive cross functional team synergy
  • Build strong relationships and a broad knowledge base across the UHG organization
  • Ensure compliance with all requirements (e.g., CMS, NCQA, Health Plan, state)

Required Qualifications:

  • MD or DO
  • Board Certified: internal medicine, geriatrician, family practice or primary care preferred
  • Active, unrestricted licensed to practice medicine
  • 15+ years’ experience in the healthcare industry in a medical administrative role
  • Experience in both the payer and provider fields
  • 5+ years’ direct clinical practice experience
  • 10+ years’ experience working in UM/DM / CM 
  • 10+ years’ experience with HEDIS, quality programs, risk adjustment
  • 10+ years’ experience managing / leading physicians and clinicians
  • Familiarity with the following :
    • Medicare, Commercial and Medicaid benchmark and trend data; Medicare regulations.  Cost of care metrics; Payment methodologies including fee for service , and capitation/delegation ; Broad and comprehensive knowledge of the care of patients in outpatient care settings including but not limited to Clinics, Ambulatory Surgery, Procedure labs, etc.  Health plan finance reporting; care models and staffing models
    • Good understanding of managed care systems, quality improvement and risk management
  • Proven ability to develop plans and strategy with technology organizations
  • Demonstrated ability to work in a highly matrixed organization
  • Knowledgeable on Delegation in managed care and on how to establish newly delegated entities
  • Strong interpersonal skills and ability to build relationships
  • Excellent presentation, writing, and negotiation skills
  • Outstanding organizational skills
  • Strong consulting skills and ability to influence others
  • Proven ability to work with people at multiple levels of the organization, multiple functions of an organization, and multiple locations
  • Willingness to travel up to 50%, first 6 months up to 75%

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system 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)



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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