Position Description 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 Connecticut 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 Connecticut 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 state.
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 regular meetings at Rocky Hill (Hartford area) office
50% day travel within the CT 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 CT
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
