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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

Medical Director, CCM - NYC & Downstate NY

UHG - New York, US

Posted: 11/19/2018

The Medical Director career with UnitedHealth Group is anything but ordinary. We push ourselves and each other to find smarter solutions. The result is a culture of performance that's driving the health care industry forward. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Join us. And start doing your life's best work. (sm)


Reporting to the Regional Medical Director, this Medical Director is a member of the Leadership Team for the NYC/Downstate NY Optum Complex Care Management team. They will work with the Senior Leadership team to develop and drive the business strategy, growth and clinical operations in the NYC / Downstate NY market. The Medical Director will help to ensure that the highest level of quality care is being delivered to the residents of our partner nursing homes. This individual will work collaboratively with the site’s advanced practice clinicians and will serve as a clinical resource when needed. The Medical Director does not provide direct patient care but rather is recognized as the clinical ‘face of the business’ related to the clinical and business communities. The Medical Director will interface with contracted nursing homes across the large and complex NYC/Downstate NY market, collaborating with a Medical Director partner and dividing approximately 11 counties.  The market encompasses the five boroughs of New York City and the contiguous counties to the immediate north.


Primary Responsibilities:

  • Achieve sustainable, profitable growth via new business development and growth
  • Promote the clinical and financial value propositions to new business and current partner stakeholders to achieve growth goals
  • Coordinate and facilitate the orientation of all new PCPs to the model
  • Routinely meet with currently collaborating PCP’s
  • Collaborate with Business Development team to identify potential SNFs / Provider Groups with new membership opportunities
  • Engage and speak with state and local organizations, LTC industry associations, medical society memberships, etc. regarding value and quality outcomes of the models
  • Develop and sustain strong relationships with other medical directors and health care system leaders in market territory
  • Actively engage NP / PA clinical staff with didactic, written and 1:1 education on geriatric syndromes, chronic illness, SNF regulations, and end of life / palliative care
  • Assist in quality of care concern case reviews and corrective action plans
  • Develop and revise clinical practice standards and procedures
  • Fulfill requirements for SNP Model of Care; State; and Federal regulations
  • Leadership role for achievement of targets for market or contract specific STAR and HEDIS measures and Quality Improvement Programs
  • Lead market review and develop education and operational plans to address pharmacy , acute hospitalization, skilled SNF services, DME, and physician medical expense
  • Provide leadership accountability for ensuring accuracy of all documentation and coding
  • Educate NP / PA staff in use of coding tools and documentation requirements
  • Attend weekly meetings at NYC Penn Plaza location
  • 30-40% day travel within the NYC/Downstate NY market


Metrics / Goals:

  • Admits per 1000 (APK; APT)
  • Readmissions
  • SNF day’s utilization
  • Key Medical Expense Metrics / Medical Expense Management
  • Overall Plan STAR Rating and individual STAR/HEDIS measures for each patient
  • Appropriate documentation and coding to attain an accurate Risk Adjustment Factor (RAF) for each patient

Required Qualifications:

  • MD or DO license in State of NY
  • ABMS Board Certified in: Internal Medicine, Family Practice, Geriatrics or Hospice/ Palliative
  • 5+ years of experience working with geriatric or long-term care population
  • Demonstrated experience working with and educating NP’s and PA’s 

Preferred Qualifications:

  • Health care management/leadership experience
  • CMS, Medicare Advantage, SNP Rules and Regulations
  • HCC and Risk Adjusted reimbursement methodology
  • Inpatient / SNF utilization metrics and bed day management
  • Financial Reports: Revenue; Expenses; Contribution Margin; Budgeting & Forecasting; BCR; IOI
  • State specific collaborative practice agreements and midlevel practitioner licensing
  • Working knowledge of EMR structures


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