[Hiring] National Accounts Medical Director @UnitedHealth Group

Role Description

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

• Promote and communicate the mission, vision, business strategy, and OPTUM value proposition to the staff through leadership meetings, educational programs, and documents.
• Work closely with Site Directors and Operations Product and Channel Leads to meet site, channel, and product goals.
• 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.
• Review business metrics, trend reports, utilization metrics, customer reports, and nurse and site performance metrics; present analysis and recommend action.
• Act as a consultant to business leaders on clinical issues related to the business model, value levers, and strategy/product/program development.
• Participate in customer and consultant presentations, audits, sales, retention efforts, and respond to questions related to clinical performance.
• Be “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; collaborate 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.
• Support community activities that enhance Community Relations and Reputation.

As Case Reviewer, Medical Directors

• Perform peer to peer discussions to promote optimal health and well-being of the individual.
• Stimulate critical thinking, assist in identification of clinical gaps, and coach staff on communication with providers and care plan development.
• Direct coordination and management of complex care issues in conjunction with enrollees’ physicians.
• Encourage principles of “6C” call conduct, Inductive Call Anatomy, warm and engaging consumer interaction, call efficiency, and good case management principles.
• Work to improve the nurse knowledge base and management of cases through various meetings and discussions.
• Adhere to medical director performance metrics and evaluations.
• Alert UHC Medical Directors to provider issues of compliance, 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.

As “Physician Liaison”, Medical Directors

• Interact with Regions, Markets, Customers, and other UHG Medical Directors to implement strategy, acquire and retain customers, and improve quality and outcomes.
• Attend Monthly Medical Expense Meetings by Region and assist with regionally based Affordability Initiatives.
• Understand and act upon Condition Specific drivers including high cost claimants and consumers with frequent utilization patterns.

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 experience 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 and interpretation skills; ability to focus on key metrics.
• Reside in Atlanta, GA or Buffalo, NY.

Compensation

Compensation for this specialty generally ranges from $248,500 - $373,000. Total cash compensation includes base pay and bonus and is based on several factors including local labor markets, education, work experience, and may increase over time based on productivity and performance in the role.

Benefits

• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase.
• 401k contribution (all benefits are subject to eligibility requirements).

Application Deadline

This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.