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Medical Director - UHC Comm. Plan of Iowa

UnitedHealth Group


Location:
Des Moines, IA
Date:
02/16/2018
2018-02-162018-03-17
Job Code:
746661
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Job Details

746661 Medical Director UHC Comm Plan of Iowa

Medical Director - UHC Comm. Plan of Iowa (746661)

Position Description

Looking for a chance to drive measurable and meaningful improvement in the use of evidence-based medicine, patient safety, practice variation and affordability? You can make a difference at UnitedHealth Group and our family of businesses in serving our Medicare, Medicaid and commercial members and plan sponsors. Be part of changing the way health care is delivered while working with a Fortune 6 industry leader.

 

Reporting to the CMO of the UnitedHealthcare Community Plan of Iowa, the Medical Director will serve to manage the non-long term support services needs of the Iowa C&S population

 

Primary Responsibilities: 

  • Responsible for appropriate utilization management including managing / monitoring the results of Care Management / Health services interventions to ensure that utilization goals are achieved; collaborating with Care Management / health services / behavioral health as necessary to maintain focus on achieving targets
  • Participates and leads healthcare affordability initiatives and meetings at the local market in partnership with the CMO and the health plan CFO – with specific attention towards pharmacy and other medical services
  • 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
  • Provides support for all external audits by state and other regulatory agencies
  • Works within our fully integrated clinical model to ensure coordination of care and identification of opportunities in the management of medical, behavioral and social determinant of care needs
  • Works in collaboration with our LTSS medical director, CMO and health services team on streamlining and improving appeals and grievances to improve provider and member experience and to ensure optimal fidelity of decisions
  • Partners with the LTSS medical director to ensure comprehensive evaluation of all services for all members as well as creation and improvement of systems to support consistent and reliable determinations
  • Partner with United Clinical Services on the quality and consistency of prior authorization processes and decisions, engaging with providers and members as needed to understand and improve our systems
  • Assist the CMO with Accountable Care Organization / Value Based Purchasing growth and execution by participating in JOCs, identifying opportunities for collaboration with external partners and supporting target setting and data analysis
  • Collaborates with the health plan Chief Medical Officer, and other clinical staff as a clinical resource and coach to establish and implement programs to support and meet the UM goals
  • Collaborates with the Chief Medical Officer, clinical operations staff, and other market staff to implement programs to support and meet market and national clinical operations goals.
  • Accountable for providing clinical leadership primarily focusing on home and community based services review and external communication with network physicians
  • May assist in the development and implementation of local plan clinical policies and procedures, quality improvement activities and performance improvement projects
  • This position will require strong leadership skills, as demonstrated by continuously improved results, team building, and effectiveness in a highly matrixed organization
  • To be successful in this position you will need excellent interpersonal communication skills and be a strong team player with team building skills

Required Qualifications:

  • MD or DO with an active, unrestricted license
  • Board Certified in an ABMS or AOBMS specialty
  • 5+ years clinical practice experience
  • Intermediate or higher level of proficiency with managed care
  • 2+ years Quality Management experience
  • Familiarity with current medical issues and practices
  • Superior presentation skills for both clinical and non-clinical audiences
  • Proven ability to develop relationships with network and community physicians and other providers
  • Excellent project management skills
  • Solid data analysis and interpretation skills; ability to focus on key metrics
  • Strategic thinking with proven ability to communicate a vision and drive results
  • Demonstrated negotiation and conflict management skills

 

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)


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.


Job Keywords: Medical Director, UHC Comm. Plan of Iowa, IA, Des Moines

Job Details

  • Contest Number746661
  • Job TitleMedical Director - UHC Comm. Plan of Iowa
  • Job FamilyMedical and Clinical Operations
  • Business SegmentCommunity and State

Job Location Information

  • Des Moines, IA
    United States
    North America

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job Level
  • ShiftDay Job
  • TravelNo
  • Telecommuter PositionNo
  • Overtime StatusExempt

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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