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LTSS Medical Director - UHC Community Plan of New Mexico

UnitedHealth Group


Location:
Albuquerque, NM
Date:
03/28/2017
Job Code:
1687149
Apply on the Company Site
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Job Details


LTSS Medical Director - UHC Community Plan of New Mexico(Job Number:685922)
Description

What makes your clinical career greater with UnitedHealth Group?  You can improve the health of others and help heal the health care system.  You can work within an incredible team culture, a clinical and business collaboration that is learning and evolving every day, and, when you contribute, you’ll open doors for yourself that simply do not exist in any other organization, anywhere.

 

Reports to the CMO of the UnitedHealthcare Community Plan of New Mexico
 

Primary Responsibilities:

  • Performs daily review of personal care attendant services to approve or deny appropriate services for members
  • Will work with nursing staff to clarify requests and documentation as needed
  • Responsible for appropriate utilization management including managing / monitoring the results of Care Management / Health services interventions to ensure that utilization goals are achieved  including NFLOC, Emod and SDCB reviews, LTSS determinations and trainings
  • Collaborates with Care Management / health services / behavioral health as necessary to maintain focus on achieving targets. 
  • Participates in healthcare affordability initiatives at the local market
  • Leads the following initiatives:
    • Pharmacy / Provider Lock-in  which includes 4 quarterly meetings and administrative work
    • Lead - Self Directed Community Benefit
      • Monthly Touchpoints with Support Brokers - now 6 agencies
      • Biweekly meeting with internal SDCB team
      • Biweekly meeting with SRT for SDCB process
      • Self Directed Community Advisory Board
    • Provider Advisory Committee in conjunction with the BH Medical Director - including coordinating meetings and seeking  new  provider members
    • State LTC Workgroup
    • Administrative Burden Reduction Task Force
    • DDW / MCO Care Coordination Work Group
    • NurseLine
    • Lead LTSS VABs, PCS Incentives including  seeking LTC VBC opportunities 
    • Provides support for all external audits by state and other regulatory agencies
    • Review and Analyze  of  Health Plan State Reports due Monthly, Quarterly, Annually as required
    • Executive Lead Meeting with Ken Smilth on LTSS
    • National Meetings including West Regional and National C&S Medical Directors, Credentialing Committee, Regional Peer Review
  • Conducts provider telephonic review and discussion, schedules on-site visits and shares tools, information and guidelines related to cost-effective health care delivery and quality of care as necessary
  • Participates in the HEDIS data collection process, CAHPS (Consumer Assessment of Healthcare Providers and Systems) improvement, and drive Health Plan accreditation activities
  • Supports all clinical quality initiatives and peer review processes
  • Effectively engages and brings understanding to our external constituents such as physicians, medical and specialty societies, hospitals and hospital associations, and state regulators
  • Works within our fully integrated clinical model working with Behavioral Health and  clinical management
  • Responsible for identifying opportunities through participation in local  and national LTSS medical expense committees or market reviews

Job Clinical Analysis & Consulting
Primary Location US-NM-Albuquerque
Other Location 
Organization C&S New Mexico ABD LTC
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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