Community and State Medical Director - Arizona
Company: UnitedHealth Group
Location: Gilbert
Posted on: May 12, 2022
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Job Description:
UnitedHealthcare is a company that's on the rise. We're
expanding in multiple directions, across borders and, most of all,
in the way we think. Here, innovation isn't about another gadget,
it's about transforming the health care industry. Ready to make a
difference? Make yourself at home with us and start doing your
life's best work.(sm)
The C&S Plan Medical Director has accountability for ensuring
that local health plan, United Clinical Services and UHC
initiatives focusing on delivering clinical excellence, quality
ratings improvement with the goal to be best in class, appropriate
inpatient and outpatient covered-service utilization and support
health care affordability. Medical Directors are expected to help
drive integrated health system transformation including working
with Accountable Care Organizations, Alternative Payment Models,
assisting to address provider network engagement and issues,
support mandated legal and contractual provisions, compliance,
growth strategies and develop/lead focused improvement projects
that are implemented and successfully managed to achieve goals.
This position reports to the local C&S plan CMO and has dotted
line relationships to the Plan CEO, C&S market-assigned
Regional Chief Medical Officer and C&S Chief Medical Officer.
The C&S Plan Medical Director primary responsibilities are
directed towards C&S plan activities as defined by the C&S
plan CEO and, also collaborates with Enterprise Clinical Services
(ECS) staff, Optum Behavioral Health staff, and other market and
regional matrix partners to implement programs to support and meet
market C&S, UHC and line of business goals. This position has
direct supervision of one or more employees, including the Adult or
Child Healthcare Administrator and close collaboration with peer
Medical Directors.
If you are located in Arizona, you will have the flexibility to
telecommute* as you take on some tough challenges.
Primary Responsibilities:
Quality + Affordability - The Plan Medical Director has primary
responsibility and accountability for medical performance and
targets for the local C&S plan(s) being overseen. This will
require a close working relationship with the plan CMO, local plan
staff, UCS and OBH clinical operations teams as well as with the
C&S and UHC national affordability team. Activities may include
conducting Joint Operations Committee meetings with prioritized
providers and Accountable Care Organizations, in coordination with
Network and ECS, contributing to and implementing programmatic and
strategic decisions, data sharing with physicians and physician
groups on quality and efficiency improvement opportunities, and
implementing local Health Care Affordability Initiatives. The
Medical director will be engaged as a clinical lead for healthcare
affordability initiatives at the local market and establishing a
process for sharing data and completing peer to peer communications
as required. Additionally, the Plan Medical Director has primary
responsibility to help support and oversee new and existing
clinical model operations, including Accountable Care
relationships, Whole Person Care and affiliated care management
programs, regulatory programs such as those defined by the Center
for Medicare and Medicaid Services (CMS) like the Model of Care.
They will support the CMO for medical dental, pharmaceutical, and
or social initiatives and quality programs as required to achieve
the appropriate utilization, affordability, HEDIS and Star goals of
the C&S Health Plan. Medical Director is accountable for
building and leaning into relationships with internal and external
partners to meet or exceed market, regional and national
requirements. The Plan Medical Director has contributing oversight
responsibility of the C&S market peer review process as defined
by State regulator as well as participating in or leading the
applicable committees such as Provider Advisory Committee (PAC) and
Healthcare Quality Utilization Management (HQUM). They will work
teams to direct all member care to in-network providers, unless
care cannot be provided in network and in state. In which case,
they will work to complete single case agreement for the highest
quality and most cost-effective care with an AHCCCS registered
provider or facility.
Clinical Excellence, Quality Standards and Service Performance -
The C&S plan Medical Director helps oversee, and contribute to,
the HEDIS and STARs process and improvement and performance
strategy, CAHPS and NPS improvement strategies and support
necessary Health Plan accreditation activities. The plan Medical
Director is required to help achieve or exceed all applicable
HEDIS, Stars and local state performance targets and goals
otherwise specified for the local C&S plan. The Medical
Director should act as an improvement catalyst for all service and
quality-related efforts, influence, participate and communicate to
ACOs and other network providers or vendors on new focus and
measure/process changes. The Medical Director supports all Clinical
Quality initiatives and peer review processes including Quality of
Care and Quality of Service (grievance) issues and is responsible
for representing the local C&S plan at State-level Fair
Hearings and performing plan-level member/provider grievance and
appeals reviews, as necessary. They will also actively participate
in or lead Physician Advisory Committees (PAC); Healthcare Quality
Utilization Management (HQUM), Quality Management Committee (QMC)
and other associated quality and/or member/provider service-focused
committees.
Innovation and Focused Improvement - As Medical Director, a culture
of innovation and continuous improvement identification is to be
incorporated at all levels of work. They are expected to
collaborate with peers, Health Services, Quality Management,
Behavioral and key health plan staff such as the Adult and Child
Healthcare Administrators and UHC network management colleagues in
efforts to transform the health system and exceed all regulatory
expectations. Local responsibilities include driving/supporting
Accountable Care Organization growth and performance improvement,
growth, APM deployment, target setting monitoring, as well as
ongoing leadership during monthly JOCs. Knowledge of payment reform
and value-based contracting variants for C&S will be required.
Medical Director is accountable for oversight or support of the
various clinical models within the market, such as Whole Person
Care, Care Advocacy, Continuum of Care and complex care
multidisciplinary rounds. Secondary responsibilities will include,
but are not limited to, other clinical practice transformation
efforts, patient-centered medical and behavioral health homes,
innovative vendor and provider-led care coordination programs,
health disparity assessments and action planning, high-performance
network development and consumer engagement.
Growth, Equity, Inclusion and Diversity - The Medical Director will
help deliver our clinical value proposition focused on quality,
affordability, and service, in support of growth activities of the
C&S Health Plan, consistent with our prevailing values and
culture. The plan Medical Director reviews and edits policies,
SOPs, communications materials as required and represents the voice
of the market-based customer in program design. Medical Director
contributes to any RFP/re-procurement activity in the state, as
requested, delivering subject matter expertise and clinical
perspectives. The Plan Medical Director actively promotes positive
relations with State/local regulatory authorities and Medical
Societies, where possible, will participate with partner
organizations, health equity and disparity efforts such as the
DE&I counsel, promote cultural competencies and other factors
which holistically help the health plan better meet community and
member needs.
Relationship Equity and State Compliance - The Plan Medical
Director maintains a solid working knowledge of all government
mandates and provisions for the local C&S market, as well as
working across the enterprise to implement and maintain compliant
clinical programs and procedures. They participate as a SME in
reviewing work plans and in operational reviews and audits. They
also are committed to being effectively and positively engaged with
our external constituents such as consumers/members, physicians,
medical and specialty societies, hospitals and hospital
associations, federal/state regulators, and market-based
collaborative. The Medical Director will work collaboratively in
these activities with ongoing ECS and C&S initiatives under the
direction of the Plan CMO, C&S Medical Director/CMO and/or the
C&S Regional CMO. The Plan Medical Director will be called upon
to support outward facing relationships to State regulators based
upon Contract, and direction of Plan CMO, Plan President and
C&S CMO and should provide clinical thought leadership with
external entities and the state. All public speaking and media
documents must be approved via appropriate UHC protocols. All
outside committee, teaching, board, or non-profit board
participation must be approved via appropriate UHC protocol.
Skills, Experiences, Qualifications:
Ability to support and contribute to a team that values
organizational and Plan success over personal success; provide
ongoing coaching and feedback with colleagues and other team
members to ensure peak performance; identify and invest in
high-potentials; actively manage underperformance
Focus staff on the company's mission and values; inspire superior
performance; ensure understanding of strategic context; set clear
performance goals; focus energy on serving the customer; provide
ongoing communication to the team; discontinue non-critical
efforts
Demonstrate pro-active, solution-oriented approaches to work
efforts and drive disciplined, fact-based decisions
Execute with discipline and urgency: Drive exceptional performance;
deliver value to the customer; closely monitor execution; drive
operational excellence; get directly involved when needed; actively
manage financial performance; balance speed with analysis; ensure
accountability for results. Medical Directors are a leadership
position within the health plan, key contributors to the "C" Suite
level team, a skilled General Manager with a clinical expertise
Proven ability to execute and drive improvements against stated
goals
Leadership Expectations:
Communicate and present effectively, listen actively and
attentively to others, and convey genuine interest
Lead change and innovation by demonstrating emotional resilience,
managing change by proactively communicating the case for change
and promoting a culture that thrives on change
Play an active role in implementing innovation solutions by
challenging the status quo and encouraging others to do so
Drive high-quality execution and operational excellence by
communicating clear directions and expectations
Manage execution by delegating work to maximize productivity,
exceed goals and improve performance
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:
Arizona Licensed physician; ideally Board Certified in an ABMS or
AOBMS specialty
Experience and/or direct working knowledge of the AHCCCS health
plan types (Complete Care; DD; LTC)
Understanding of dual Special Needs health plans (DSNP) and
Medicare/Medicaid integration
Clinical, professional interest in special needs populations and
fully integrated healthcare models
Willingness to travel locally, in Arizona, to communities where
clinical partnerships require face to face interactions
Full COVID-19 vaccination is an essential requirement of this role.
Candidates located in states that mandate COVID-19 booster doses
must also comply with those state requirements. UnitedHealth Group
will adhere to all federal, state and local regulations as well as
all client requirements and will obtain necessary proof of
vaccination, and boosters when applicable, prior to employment to
ensure compliance
Preferred Qualifications:
5+ years of clinical practice experience; solid knowledge of
managed care industry and the Medicaid line of business
2+ years of Quality management experience
Familiarity with current medical issues and practices
Proficiency with Microsoft Office applications
To protect the health and safety of our workforce, patients and
communities we serve, UnitedHealth Group and its affiliate
companies require all employees to disclose COVID-19 vaccination
status prior to beginning employment. In addition, some roles and
locations require full COVID-19 vaccination, including boosters, as
an essential job function. UnitedHealth Group adheres to all
federal, state and local COVID-19 vaccination regulations as well
as all client COVID-19 vaccination requirements and will obtain the
necessary information from candidates prior to employment to ensure
compliance. Candidates must be able to perform all essential job
functions with or without reasonable accommodation. Failure to meet
the vaccination requirement may result in rescission of an
employment offer or termination of employment
Careers at UnitedHealthcare Community & State. Challenge brings out
the best in us. It also attracts the best. That's why you'll find
some of the most amazingly talented people in health care here. We
serve the health care needs of low income adults and children with
debilitating illnesses such as cardiovascular disease, diabetes,
HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based
approach considers social, behavioral, economic, physical and
environmental factors. Join us. Work with proactive health care,
community and government partners to heal health care and create
positive change for those who need it most. This is the place to do
your life's best work.(sm)
All Telecommuters will be required to adhere to UnitedHealth
Group's Telecommuter Policy.
Colorado, Connecticut or Nevada Residents Only: The salary/hourly
range for Colorado residents is $254,600 to $295,200. The
salary/hourly range for Connecticut/Nevada residents is $254,600 to
$295,200. Pay is based on several factors including but not limited
to education, work experience, certifications, etc. In addition to
your salary, UnitedHealth Group offers benefits such as, a
comprehensive benefits package, incentive and recognition programs,
equity stock purchase and 401k contribution (all benefits are
subject to eligibility requirements). No matter where or when you
begin a career with UnitedHealth Group, you'll find a far-reaching
choice of benefits and incentives.
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.
Keywords: UnitedHealth Group, Gilbert , Community and State Medical Director - Arizona, Executive , Gilbert, Arizona
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