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National Accounts Medical Director Buffalo NY (Physician #)

Company: Optum
Location: Tonawanda
Posted on: September 21, 2019

Job Description:

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. Join us. And start doing your life's best work.(sm)

We are currently seeking a National Accounts Medical Director to sit in our Tonawanda, NY office. 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.

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 readmissions
      • 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 utilizationRequired Qualifications:
          • MD or DO with an active, unrestricted medical license
          • Current Board Certification in an ABMS or AOBMS specialty
          • 3+ years clinical practice experience
          • 2+ years managed care including UM, CM, Affordability/ Cost savings initiatives, Quality Management experience and / or administrative leadership experience
          • Solid data analysis and interpretation skills; ability to focus on key metrics
          • Proficiency with Microsoft Office applications
            Preferred Qualifications:
            • Excellent written and oral communication skills with customer facing experience
            • Excellent project management skills
              Transforming health care and millions of lives starts with the values you embrace and the passion you bring. Find out more and join us. It's an opportunity to do your life's best work.(sm)

              Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system 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 together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

              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.

              Job Keywords: National, Client, Medical Director, Buffalo, New York, Affordability, UM, CM, Managed Care Keyphrases: health administration jobs, medical director jobs, hospital administration jobs, hospital administrative jobs, healthcare administration jobs, administration jobs, healthcare administrator jobs, medical administration jobs, chief medical officer jobs, medical director position jobs, associate medical director jobs, medical administrative jobs, healthcare ceo jobs, medical ceo jobs, executive director jobs

Keywords: Optum, Buffalo , National Accounts Medical Director Buffalo NY (Physician #), Executive , Tonawanda, New York

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