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Chief / Associate Chief Medical Director - White Plains, NY

UnitedHealth Group


Location:
White Plains, NY
Date:
06/23/2017
2017-06-232017-07-22
Job Code:
1739676
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Job Details


Chief / Associate Chief Medical Director - White Plains, NY(Job Number:710741)
Description

You're looking for something bigger for your career. How about inventing the future of health care? UnitedHealthcare is offering an innovative new standard for care management. We're pushing ourselves and each other to find smarter solutions. The result is a culture of performance that's driving the health care industry forward.


What makes your clinical career greater with UnitedHealth Group? You can improve the health of others and help heal the health care system. Be a leader that is shaping our incredible team culture and be a part of a clinical and business collaboration that is learning and evolving every day.

 

The OrthoNet Chief Medical Officer/Associate Chief provides leadership, organization, and direction for all utilization management programs and other Medical Department services.  Responsible for the overall quality, effectiveness and coordination of the utilization management and other managed care services provided through OrthoNet/Optum.

 

Directs the Utilization Management and Quality Improvement and Accreditation programs for the company/business unit, will oversee/direct/supervise the monitoring of utilization management and all other applicable managed care health services activities. The Chief Medical Officer/Associate Chief provides direction and oversight in the development and implementation of clinical and administrative policies and procedures and any needed clinical criteria for all medical programs and services that are part of the Company’s programs. .

 

Directs or shares direction of focused claim and related special review programs.  Helps to improve existing program and to create new opportunities for this business.

 

He/she will serve as the primary liaison between OrthoNet and other physicians; and OrthoNet and other medical service providers with whom we interact on health services and managed care programs.

 

Primary Responsibilities:

 

(A)  Utilization Management, Health Services Delivery and other Managed Care Programs

  • Directs the utilization management, quality improvement and accreditation activities
  • Monitors all relevant reports, information summaries, clinical and financial data relating to these activities and works with senior management to further improve overall company performance
  • Provides direction for development and implementation of new utilization management, population health, provider and member integrated health care operations and other activities
  • Oversees the development and implementation of policies and procedures to ensure effective monitoring and management of managed care activities
  • Oversee implementation of a risk assessment process for the member population/population health programs and other innovative health care activities
  • Participation in Training regarding URAC, NCQA, CMS and other Regulatory Compliance,
  • Represents OrthoNet in broader company activities and program development as required.
  • Provides guidance for programs in payment integrity and professional/other services claim coding

 (B)  Committee Responsibilities

  • Works with appropriate committees and task forces to assist OrthoNet credentialing and network operations
  • Chairs/Serves on utilization management, quality improvement and other OrthoNet activities. Assists as required with company activities of this type

(C)  Focused claim and other professional claim review programs

  • Directs (or shares direction) of the existing and future program efforts involving targeted professional and other claim reviews

(D)  Network and Provider Services

  • Advises and assists the credentialing activities required for physician and physical therapy networks as needed
  • Assists the Provider Relations, customer service and other staff with resolving provider and payor issues including, but not limited to clinical inquiries, claims issues, fee schedule concerns, medical policies, procedures and member/provider appeal coordination

(E)  Liaison Activities

  • Maintains liaison relationships with payors and providers in the community as required
  • Serves as the primary contact with clients/managed care clients and participating providers regarding OrthoNet activities
  • Represents OrthoNet as required in other company business
  • Represents OrthoNet in marketing to existing and new customers

(F)  Regulatory Requirements

  • Monitors compliance with regulatory agency standards and requirements (i.e. CMS, NCQA, RAC, state/federal and third party payors)

(G) Other Activities

  • Perform all other duties as assigned

Job Clinical Analysis & Consulting
Primary Location US-NY-White Plains
Other Location 
Organization Consumer Solutions Finance
Schedule Full-time
Number of Openings 1
Apply on the Company Site

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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