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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 - UHC Community Plan of Texas

UHG - Houston, Texas

Posted: 11/12/2018

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. We'll put you in the driver's seat on vital projects that have strategic importance to our mission of helping people lead healthier lives. We need your organizational talents and business discipline to help fuel ours.
This position is responsible for clinical leadership and execution of the Texas Medicaid and D-SNP programs, in collaboration with the health plan Chief Medical Officer and health plan medical director colleagues.  The Medical Director has accountability for ensuring that health plan initiatives associated with the Medicaid and D-SNP membership, and focusing on clinical excellence, quality ratings improvement, affordability, mandated provisions and compliance, growth and focused improvement, are implemented and successfully managed to achieve goals.
We're focused on improving the health of our members, enhancing our operational effectiveness and reinforcing brand and reputation for high-quality health plans. Join us and help guide our efforts to improve the patient experience. It takes passion, commitment, intense focus and the ability to contribute effectively in a highly collaborative team environment.
Key Activities:
- Reports to health plan Chief Medical Officer (CMO), with accountability to health plan’s Executive Directors of the STAR+PLUS, Children’s Programs and D-SNP/MMP teams.
- Leadership role in local clinical operations and clinical quality initiatives
- Collaborates with CMO, ED, Vice President of Health Services, Senior Director of Quality Management and other health plan clinical and operations leadership to implement programs to support the membership and to meet health plan goals
- Works toward fully integrated clinical model, providing support and guidance to service coordinators and care managers, and other clinical staff including transitional care management, disease management, and behavioral health teams
- Liaison to network management for physician and provider network development related to acute care and Home- and Community-Based services.
- Manages external physician relationships, acts as community ambassador, and works with Executive Directors in developing new business opportunities

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

Primary Responsibilities:
  • Clinical Excellence – This medical director acts as an improvement catalyst for clinical quality efforts including state Pay-for-Quality program-related initiatives and Medicare (D-SNP) Star ratings initiatives.  Facilitates alternative payment models with providers by clinical data sharing with physicians and other providers.  Promotes implementation of accountable care communities (patient centered medical homes).  Responsible for complex case reviews with care coordinators and clinical staff.  Supports peer review processes including Quality of Care issues.  Engaged in state Fair Hearings as required.  Serves as liaison for Network development.  Holds internal and external stakeholders accountable for their roles in the Care Continuum by supporting health plan quality of care and medical expense management.
  • Affordability – This medical director ensures appropriate quality practices and utilization management from a macro view, for example, conducting hospital and physician practice Joint Operations Committee meetings jointly with Network Management, data sharing with physicians and physician groups on quality and efficiency improvement opportunities, and implementing local Health Care Affordability Initiatives.
  • Relationship Equity – This medical director maintains a strong working knowledge of relevant government mandates and provisions, working across the enterprise to implement and maintain compliant clinical programs and procedures.  Provides support for all external audits by state and other regulatory agencies.  S/he also is committed to being effectively engaged with our external constituents such as consumers/members, physicians, medical and specialty societies, hospitals and hospital associations, federal/state regulators, and market-based collaboratives. This commitment to regular, proactive dialogue will lead to collaboration around programs focused on improving health care to our members.

Required Qualifications:
  • Physician with an active, unrestricted Texas medical license
  • Board Certified in an ABMS or AOBMS specialty
  • 5+ years clinical practice experience
  • 2+ years experience with Managed Care, with Intermediate or higher level of proficiency
  • 2+ years Population Health or Quality Management experience
Preferred Qualifications:
  • Medicaid managed care
UnitedHealthcare Community & State is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.
If you're ready to help make health care work better for more people, you can make a historic impact on the future of health care at UnitedHealthcare Community & State.
We contract with states and other government agencies to provide care for over two million individuals. Working with physicians and other care providers, we ensure that our members obtain the care they need with a coordinated approach.
This enables us to break down barriers, which makes health care easier for our customers to manage. That takes a lot of time. It takes a lot of good ideas. Most of all - it takes an entire team of talent. Individuals with the tenacity and the dedication to make things work better for millions of people all over our country.
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.

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