Market Medical Director - Southern California(Job Number:703507)
The Market Medical Director (MMD) has accountability for ensuring that United Clinical Services initiatives focusing on clinical excellence, quality ratings improvement, appropriate inpatient and outpatient utilization, affordability, mandated provisions and compliance, growth and focused improvement are implemented and successfully managed to achieve goals. This position is responsible for market-based clinical leadership and execution of all healthcare affordability initiatives and clinical quality activities. The market medical director collaborates with the market CEO, United Clinical Services (UCS) staff, and other market and regional matrix partners to implement programs to support and meet market UCS and line of business goals, as well as network and sales objectives. The MMD is also responsible for providing direction and oversight in collaboration with matrix partners and reports to the Regional Chief Medical Officer with accountability to the local market CEO and the market’s senior management team.
• Quality and Affordability – This medical director has responsibilities for appropriate utilization management from a “macro” view, for example, conducting hospital Joint Operations Committee meetings with Network, contributing to--and implementing--regional Medical Cost Operating Team decisions, data sharing with physicians and physician groups on quality and efficiency improvement opportunities, and implementing local Health Care Affordability Initiatives. Clinical lead for healthcare affordability initiatives at the local market and establishing a process for sharing data with hospitals and physicians and completing peer to peer communications as required. Support UHN initiatives and Quality Affordability Programs as required in order to achieve the appropriate inpatient and outpatient utilization and affordability goals of the Health Plan and United Clinical Services.
• Clinical Excellence – This medical director helps oversee the HEDIS data collection process, CAHPS improvement, and drive Health Plan accreditation activities as well as quality rating initiatives. Acts as an improvement catalyst for all quality-related efforts including Center for Medicare and Medicaid Services Star initiatives. Communicate to providers on new focus and measure/process changes. Supports all Clinical Quality initiatives and peer review processes including Quality of Care and Quality of Service issues.
• Relationship Equity—This medical director maintains a strong working knowledge of all government mandates and provisions, working across the enterprise to implement and maintain compliant clinical programs and procedures. S/he also is committed to being effectively 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. This commitment to regular, proactive dialogue will lead to collaboration around programs focused on improving health care to enrollees and better products for our customers.
• Innovation—This medical director leads the clinical interface with care providers and UHC network management colleagues in efforts to transform the health system, including, but not limited to, UHC’s Accountable Care Platform, value-based contracting, clinical practice transformation, patient-centered medical homes, accountable care communities, accountable care organizations, transparency initiatives such as UnitedHealth Premium® Designation, creative care management programs, high-performance networks and network optimization, consumer engagement, and value-based benefit designs.
• Growth – This medical director delivers the clinical value proposition focused on quality, affordability and service, in support of the sales and growth activities of the Health Plan including conducting Broker/Client presentations and participating in customer consultations. S/he reviews and edits communications materials as required, and represents the voice of the market-based customer in program design. S/he actively promotes positive relations with State/local regulatory authorities and Medical Societies.
• Focused Improvement – This medical director is responsible for identifying opportunities through participation in regional and local Medical Cost Operating Teams or Market reviews. S/he actively participates in Joint Operating Committees. S/he also provides local feedback on and oversight of the performance Optum Behavioral Solutions, and OptumHealth as needed. Additional responsibilities include the timely collection and entry of information into Online Engagement Survey tools and scorecards; developing action plans for sub-optimal results; and taking a leadership role in United Clinical Services and Quality Affordability Programs initiatives.
Demonstrable Skills and Experiences:
• Ability to build a team that values organizational success over personal success; provide ongoing coaching and feedback to ensure peak performance; identify and invest in high-potentials; actively manage underperformance.
• Focus staff on the company's mission; 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.
• 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.
• Drive change and innovation though continually seeking and implementing innovative solutions; create a culture that thrives on continuous change; inspire people to stretch beyond their comfort zone; take well-reasoned risk; challenge "the way it has always been done"; change direction as required
• Model and demand integrity and compliance
• Proven ability to execute and drive improvements against stated goals.
• Ability to develop relationships with network and community physicians and other providers.
• Visibility and involvement in medical community
• Ability to successfully function in a matrix organization.
Job Clinical Analysis & Consulting
Primary Location US-CA-Los Angeles
Other Location US-CA-WEST HILLS-California, US-CA-Laguna Hills, US-CA-Anaheim, US-CA-Long Beach, US-CA-Irvine, US-CA-Pasadena, US-CA-NORTH HOLLYWOOD, US-CA-Cypress
Organization Central/West Region MMD
Number of Openings 1