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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

LTSS Medical Dir.- UHC - Community Plan VA

UHG - Virginia, US

Posted: 12/12/2018

Looking for a chance to drive measurable and meaningful improvement in the use of evidence-based medicine, patient safety, practice variation and affordability? You can make a difference at UnitedHealth Group and our family of businesses in serving our Medicare, Medicaid and commercial members and plan sponsors. Be part of changing the way health care is delivered while working with a Fortune 6 industry leader. Delivering mission driven comprehensive innovative care to improve the health of our members and improve the care delivery system. This position will report to the Market Chief Medical Officer.


If you are located in Virginia, you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:


  • Work to improve quality and promote evidence-based medicine

  • Provide information on quality and efficiency to doctors, patients and customers to inform care choices and drive improvement

  • Support initiatives that enhance quality throughout our national network

  • Ensure the right service is provided at the right time for each member

  • Work with medical director teams focusing on inpatient care management, clinical coverage review, member appeals clinical review, medical claim review and provider appeals clinical review

  • Oversee and be responsible for all LTSS including LTSS clinical leadership and execution of all health care affordability and clinical quality initiatives to achieve goals

  • Works collaboratively with the Behavioral Health, pharmacy benefits, member outreach departments to integrate social, behavioral and physical health and improve clinical program execution

  • Accountable for quality initiatives to improve HEDIS and other quality ratings

  • Collaborates with the local provider community, and with state regulatory agencies to improve care

  • Participates in scheduled LTSS and D-Snp team meetings, case rounds, complex case rounds, Hotspotting rounds

  • Interacts with the Plan’s membership, physician community, health systems, nursing facilities, home and community based networks

  • Outward facing position to also interact with medical / physical professional associates, government representatives and advocacy groups to advance clinical excellence and the delivery of cost efficient care

  • Assist with utilization management and appeals

  • Assist in meetings with state Medicaid department

Required Qualifications:

  • MD or DO degree

  • Active, unrestricted physician Virginia license

  • Must be clear of any/all sanctions by Commonwealth of Virginia or Office of the Inspector General

  • Must not be prohibited from participating in any Federally or State funded healthcare programs

  • Current board certification in ABMS or AOA specialty

  • 5+ years of clinical practice experience post residency, including experience with LTSS populations and services

  • Strong understanding of and concurrence with evidence-based medicine (EBM) and managed care principles

  • Minimum of three years of medical management and general management experience, preferably in a managed care environment

  • Valid Virginia drivers license

Preferred Qualifications:

  • Hands-on utilization and/or quality management experience

  • Project management or active project participation experience

  • Substantial experience in using electronic clinical systems

Transforming health care and millions of lives starts with the values you embrace and the passion you bring. Find out more and join us. It’s an opportunity to do your life’s best (sm)


Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.(sm)


*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

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.


Job Keywords: Physician executive, clinician, utilization management, Milliman, Interqual, doctor, appeals, bed days, pmpm, clinical quality

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