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Senior Inpatient Case Management Medical Director - Virtual

UnitedHealth Group

New York, NY
Job Code:
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Job Details

Senior Inpatient Case Management Medical Director - Virtual(Job Number:713566)

Senior Inpatient Case Management Medical Director United Clinical Services

Purpose of Job:
UnitedHealthcare Clinical Services (UCS) conducts medical management activities for commercial and government business.. The majority of these activities are concentrated in inpatient review and appropriate inpatient utilization, although depending upon location and products covered, functions such as pre-certification and other traditional utilization management activities may be performed. The UCS medical director is part of a national organization and team, and will collaborate with UCS peers, market medical directors and others from across the country. In response to customer need and expectation, UnitedHealthcare is continuously modifying its programs and approaches. Although not a primary job function, medical directors with the interest in doing so often have the opportunity to be involved with change design and management.
• UnitedHealthcare’s care management approach is data driven, and grounded in the use and application of evidence based medicine (EBM) and guidelines. The successful UCS medical director appreciates and understands data, is a champion of and is very conversant with evidence-based medicine, and uses nationally recognized clinical guidelines to teach and direct clinical staff, as well as engage the practicing community in discussions designed to result in individual patients receiving the right care, in the right place, at the right time.
• Senior clinical executive represented on the Regional Executive Management Team and responsible for contributing to the policy and operational objectives of the region
• Senior clinical liaison to regional Network Management, Sales, Underwriting, Regulatory Affairs, Operations and Public Affairs for the region
• Senior clinical executive participates in the development and execution of national clinical strategies and programs, clinical operations, and clinically integrated networks
• Leadership for the network medical management, or field-based medical management programs and results, including inpatient and professional outcomes and trends
• Leadership for regionally developed health care affordability initiatives and execution of national affordability initiatives
• Senior clinical executive responsible for health care quality, quality improvement, HEDIS/CAHPS performance, accreditation and compliance programs, physician engagement and improvement, local physician professional society liaison, regulatory agencies, local quality improvement coalitions, etc.
• Provides regional executive management with information/tools for strategic decision making and planning.
• Provides consultative advice to regional network management regarding the medical delivery system, enhancement to services, provider patient care issues.
• Ensures integrity of functional areas for compliance with state and federal guidelines.
• Interfaces with medical societies and other regional collaborations.
• Provides clinical leadership to regional sales efforts.

Job Clinical Analysis & Consulting
Primary Location US-NY-New York
Other Location US-WA-Seattle, US-FL-Tampa, US-TX-Houston, US-AZ-Phoenix, US-IL-Chicago, US-CA-Los Angeles
Organization UCS Sr Mgmt
Schedule Full-time
Number of Openings 1
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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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