UnitedHealth Group is among the most ambitious Fortune 25 companies you'll ever meet. Through our family of businesses, we're working to make the health care system perform better for more people, in more ways than ever.
Simply put, we think the entire system can be greater than it's ever been. And that drives us to work harder, aim higher, and expect more from one another.
Here, you'll be empowered to make an immediate impact for millions of others. And you'll achieve more than you ever expected. How does that fit with your plans?
Telecommuter Medical Director, Medicare-Americhoice-Phoenix-315156
UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health.
Description AmeriChoice 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 AmeriChoice.
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.
- Provides clinical leadership to the Medicare ICCT team and is accountable for managing utilization and outcomes of the team.
- Collaborates with the RCMO, ICCT team and other clinical staff to establish and implement clinical programs to support and meet the UM goals.
- Conducts Medical Director activities primarily focus on support of the daily review activities and external interaction and communication with network physicians.
- Over see daily and on going over site of clinical reviews and evaluation of clinical care and services provided to plan members.
- Interacts, communicates, and collaborates with network and community physicians, hospital leaders, and other vendors regarding clinical care and services for enrollees.
- Facilities and uses performance data to guide interactions.
- Oversees provider telephonic review and discussion, and shares tools, information and guidelines related to quality, cost-effective health care delivery and quality of care.
- Over sees peer-to-peer dialogue to review issues, develop collaborative intervention plans and share ideas about network management issues.
- Meets all targeted benchmarks.
- Over sees documentation of case review findings, actions, and outcomes in accordance with policies; meets health plan inter-rater reliability guidelines.
- Over sees daily conferences (rounding) with ICCT team to identify delays in care, facilitate discharge planning, and develop follow up action to address care coordination issues.
- Is available and accessible to the Medical Directors and ICCT team throughout the day to respond to clinical issues
- Serves as a clinical resource, coach, and leader for ICCT team.
- Shares best practices with other medical directors and clinical leaders from other regional sites.
- Directs weekly team meetings and rounds for communication, feedback, problem solving, staff training and development and sharing of program results.
- Facilitates access to clinical specialty panel physicians to assist in complex or difficult cases.
- Develop and monitors utilization reports by product line, identifying changes in utilization or access patterns and monitor overall trends on a weekly basis.
- Interacts with RCM to develop HCQAI plans and to implement strategic initiatives and tactics to address areas of concern and monitors progress towards goals.
- Interacts with RCMO to ensure coordinated approach to delivery system providers.
- Participates in design and development of care programs and national committee's requested.
You can be a part of this team. You can put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered. Qualifications Qualifications:
- Current and non-restricted licensed physician; Board Certified in ABMS specialty
- 5+ years post-licensure experience as a senior clinician and leader with responsibility for clinical standards, quality management, and clinical supervision in a health plan organization.
- 5+ years experience in Medicaid/Medicare government programs or Medicare fee for services highly preferred.
- Demonstrated accomplishments in the areas of medical care delivery systems, utilization management, quality management, and peer review.
- Strong operational focus with demonstrated data analysis / interpretation acumen, project management, change management, and execution skills.
- Self-motivated and able to work with little direct supervision and drive results with disciplined follow-though.
- Strong strategic thinking and business acumen with the ability to align clinical related strategies and recommendations with business objectives.
- Adaptable and flexible style of collaborating with key stakeholders in setting direction.
- Proven ability to quickly gain credibility, influence and partner with employees, business leaders and the clinical community.
- High integrity with a reputation of a trusted confidential advisor and partner.
- Visibility and involvement in medical community.
- Ability to develop relationships with network and community physicians and other providers.
- Excellent presentation skills for both clinical and non clinical audiences.
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. |
