Medical Director - Complex Pop Health Management - Brentwood, TN(Job Number:699765)
You're looking for something bigger for your career. How about inventing the future of healthcare? 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. As an Associate Medical Director you will use your talents to take our already exceptional service and innovation to the next level. You will lead a team of world-class professionals who are removing barriers to better health with every new idea. Ready for a new path? Join us and start doing your life's best work(sm). 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 TN CnS health plan manages approximately 500 k covered lives to include a DSNP population. TennCare Medicaid and Choices (Long Term Services and Supports).
The Associate Medical Director has accountability for developing and supporting our population health program, including the management of special needs populations. The Associate Medical Director will be responsible for assigned health plan initiatives on affordability, quality and clinical excellence, as well as growth in membership. Depending on the level of experience, interest and expertise, programs these could include children’s EPSDT programs, maternity programs for high risk pregnant members, those member who are dually eligible for Medicaid and Medicare, and members in the TennCare Long Term Services and Supports or Employee Community First Choices.
- Collaborates with the market lead Chief Medical Officer and various program directors, clinical quality , population health , operations , compliance and other market staff to implement programs to support and meet state and national clinical operations goals
- Provides support and guidance to the community care teams of care coordinators, care managers, behavioral specialists, community health workers, and other clinical staff
- Works toward fully integrated clinical model working with Behavioral Health and Choices clinical management, and leads coordination of clinical activity with other state programs such as the DIDD program for TennCare member with intellectual and developmental disability
- Reports to Health plan Chief Medical Officer with accountability to various clinical program leaders
- Leadership role in local clinical operations and initiatives
- Manages external physician relationships as needed, acts as community ambassador, and works in developing new business opportunities as required
- Participates in and may lead quality evaluations, committees and subcommittees, and peer review activity
- Represents the health plan in various TennCare activities to include the state payment reform initiative and various other programs and meetings as needed
- Responsible for managing/monitoring the financial results of Care Management/Health Services interventions and initiatives to ensure that utilization goals are achieved; collaborating with Care Management/Health Services/Behavioral Health as necessary to maintain focus on achieving targets
- Develops new ideas for affordability initiatives in the population and drive their implementation when selected
- Supports local market data, sharing activities which include: reviewing completed data analysis and establishing a process for sharing data with facilities, physicians, and other providers as needed
- Responsible for complex case reviews and rounds with clinical staff, care managers, and IDD care coordinators
- Delivers the clinical value proposition in support of the sales and or growth activities of the Health Plan
- Promotes positive relations with State/local regulatory authorities and Medical Societies
- Active participation in support of Joint Operating, QM, and PAS Committees
- Coordinates care with the local integrated behavioral health teams
Job Clinical Analysis & Consulting
Primary Location US-TN-Brentwood
Organization C&S Tennessee
Number of Openings 1