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Requisition number: 2392044

Job category: Medical & Clinical Operations

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

Medical Director careers at UnitedHealth Group are 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 one patient at a time, you have the opportunity to impact health care trend across the population with data driven information and tools to drive evidence based care.

We are currently seeking a National Accounts Medical Director to join our team. The Medical Director will take a member centric approach to help the health system work better and to promote best in class care management. This includes meeting with external stakeholders, program and product design improvement, site related audits and improvement initiatives.

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

As the team's clinical leader, Medical Directors:

+ Promote and communicates the mission, vision, business strategy and OPTUM value proposition to the staff through leadership meetings, educational programs and documents, program and tool development, and case discussions

+ Work closely with Site Directors and Operations Product and Channel Leads to meet site, channel, and product goals

+ Serve to develop, improve, and evaluate the critical thinking skills of the nurses, to achieve the highest quality and efficiency outcomes

+ Provide leadership, training and coaching for nurses in:

+ Clinical opportunity identification, intervention and care plan development

+ Promotion of use of network providers, UnitedHealth Care Premium Providers, or other quality rated physicians

+ Internal partner referrals

+ Risk management and quality of care issues

+ Foster, create and maintain a professional and respectful work environment to boost staff morale, satisfaction, and retention, commitment and engagement

+ Review business metrics, trend reports, utilization metrics, customer reports, and nurse and site performance metrics and presents analysis and recommends action

+ Act as a consultant to the business leaders on clinical issues related to the business model, value levers, and strategy / product / program development

+ Participate in customer and consultant presentations, participation in audits, sales, retention efforts and respond to questions related to clinical performance

+ "On call" for questions and issues related to utilization and medical expense reduction efforts for customers and consultants

+ Serve on project teams as a leader, participant, and/or consultant; collaborates with internal business partners to promote value levers and other strategic initiatives

+ Work collaboratively with customers on mutually defined goals

+ Serve as a resource and a frequently requested clinical expert for outside prospects and customers by assisting the sales and account management teams with client meetings

+ Support community activities that enhance Community Relations and Reputation

As Case Reviewer, Medical Directors:

+ Perform peer to peer discussions when indicated which promote optimal health and well-being of the individual

+ Through one-on-one discussions as well as Medical Director Value Case Reviews with nursing staff, stimulates critical thinking, assists in identification of clinical gaps, and coach staff on communication with providers and on care plan development

+ Direct coordination and management of complex care issues in conjunction with enrollees' physicians and proposes care plans to prevent readmission

+ Encourage the principles of "6C" call conduct, Inductive Call Anatomy, warm and engaging consumer interaction, call efficiency, good case management principles, and focus on measurable outcomes

+ In conjunction with Clinical Managers, works to improve the nurse knowledge base and management of cases, through site leadership meetings, clinical teaching sessions, team meetings, case audits, nurse tools and one-on-one case discussions

+ Adhere to medical director performance metrics and evaluations

+ Knowledge of admission, readmission data and overall medical expense that would drive changes in focus at the case level

+ Alert UHC Medical Directors to provider issues of compliance with UHC protocols, over utilization, quality of care issues, and lack of adherence to EBM guidelines

+ Support quality reviews, inter-rater reliability sessions, regulatory requirements, and accreditation and certification efforts including performing audits and participating in quality clinical improvement studies

As "Physician Liaison", Medical Directors:

+ Interact with Regions, Markets, Customers, and other UHG Medical Directors, Sales, Account Management, Clinical Solutioning, Health Plan Medical Directors, Network Management, and OptumHealth partners to implement strategy implement products and programs, acquire and retain customers, and improve the quality and outcomes of the consumers navigating care delivered by the provider network and to improve relationships between the organizations

+ Attend Monthly Medical Expense Meetings by Region and assist with regionally based Affordability Initiatives with a focus on admission, readmission overall bed day management

+ Understand and act upon Condition Specific drivers including high cost claimants and consumers with a pattern of frequent utilization

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

+ MD or DO with an active, unrestricted medical license

+ Active board certification from the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA

+ 3+ years of clinical practice experience

+ 2+ years of managed care including UM, CM, Affordability/ Cost savings initiatives, Quality Management experience and / or administrative leadership experience

+ Proficiency with Microsoft Office applications

Preferred Qualifications:

+ Proven excellent written and oral communication skills with customer facing experience

+ Proven excellent project management skills

+ Proven solid data analysis a...

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