UHG

About UHG

Careers at UnitedHealth Group

 

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

Country:

United States

Postal Code:

84081

Approximate Salary:

Not Specified

Position Type:

Full Time

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Medical Director - Salt Lake Valley, Utah

UHG - West Valley City, Utah

Posted: 09/2/2018

You're looking for something bigger for your career. How about inventing the future of health care? UnitedHealthcare is offering an innovative new standard for care management. We're pushing ourselves and each other to find smarter solutions. The result is a culture of performance that's driving the health care industry forward. As a Medical Director you will use your talents to take our already-exceptional service and innovation to the next level. You will lead a team of world-class professionals who are removing barriers to better health with every new idea. Ready for a new path? Join us and start doing your life's best work.(sm)   OptumCare is a network of health care providers in the Southwest, whose mission is to connect and support providers by working together to deliver the most effective and compassionate care to each and every patient they serve.  OptumCare’s focus is to do the right things for patients, physicians, and the community. OptumCare’s Core Business is contracting directly with health insurers to deliver a highly personal care management and service model to their patients.  The current focus of OptumCare is on seniors, and those with complex care needs, who most benefit from a high touch model of care.   The Medical Director for Optum Collaborative Care in UT will report to the Chief Medical Officer (CMO).  The Medical Director will assist the CMO in directing the clinical strategy in the market.  This individual will work to build strong, trusted relationships with other providers to influence and change behavior in a collaborative way. The Medical Director will be required to work cross-functionally and will be expected to provide insight and perspective from the network point of view to the CMO and leadership team. They will support the CMO with utilization management (UM), prior authorization determinations, oversight and direction of inpatient and skilled nursing facility utilization, oversight and direction of Outpatient Care Management Services, Medicare Risk Adjustment Factor (RAF) education as well as HEDIS/STARS education, and provider/group relationship building.  This individual may be meeting with providers in the care delivery setting and will work with them and the CMO to identify opportunity for improvement in clinical documentation, coding and effective utilization.   Primary Responsibilities:

  • Executing timely case review and PA determination
  • Conducting provider telephonic review and discussion
  • Assisting with oversight of the HEDIS data collection process, CAHPS (Consumer Assessment of Healthcare Providers and Systems) improvement, and drive Health Plan accreditation activities
  • Apply understanding of patient care quality metrics (e.g., HEDIS; 5 STAR; disease-based metrics) in order to drive/achieve quality outcomes
  • Supporting all clinical quality initiatives and peer review processes
  • Effectively engaging and bringing understanding to our external constituents such as physicians, medical and specialty societies, hospitals and hospital associations, and state regulators
  • Identifying opportunities through participation in local medical expense committees or market reviews
  • Provide assistance in appeals review where appropriate
  • Assist in RAF/HEDIS/STARS education to improve metrics
  • Other duties as assigned by the CMO

Required Qualifications:
  • MD or DO with an active, unrestricted license in UT or ability to obtain one
  • Board Certified in an ABMS or AOBMS specialty
  • 5+ years clinical practice experience
  • Experience and knowledge of Medicare advantage programs (STARS, RAF, etc)
  • Working knowledge of managed care
  • Experience with identifying Medicare risk adjustment and presenting findings to client/providers
  • Experience with patient care quality metrics (e.g., HEDIS; 5 STAR; disease-based metrics) in driving/achieving quality outcomes
  • Ability to apply accurate diagnostic codes in order to maximize risk adjustment
Preferred Qualifications:
  • Working with senior leadership team to strategize and assess market trends etc.
  • Experience within managed care
  • 2+ years Quality Management experience
  • Collaborates with Market Operations and Provider Relations staff in the market(s)
  • Assists in the identification of potential physician practice acquisitions in assigned market
  • Partnering with the Clinical Affordability team to support new innovative approaches to making healthcare more efficient and meaningful to PCPs and patients alike; ultimately bending the cost curve in region
  • Developing and cascading clinical outcome/improvement messaging to business units to foster tighter working culture
  • Helping set agendas/strategies and leading multifaceted teams of Physician Business Managers, Risk Adjustment RNs, and Quality RNs
  • Assist driving aligned performance in largely an independently contracted provider network through the development of meaningful relationships,  financial and quality incentives, best practices, forward thinking solutions to improve our value proposition to medical providers
  • Assist in the identification and development of current/new best practices in support of continuous financial and quality improvement
  • Serve as an integral dyad partner interfacing with Corporate level support divisions, to include: Quality, Risk Adjustment, Cost and Care

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: 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: Medical Director, Clinical, Doctor, Managed Care, Physician, Clinician, ABMS, AOBMS, quality management, West Valley City, Salt Lake City, UT, Utah

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