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Senior Medical Director Calif MMIS

UnitedHealth Group

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Job Details

747360 Senior Medical Director Calif MMIS

Senior Medical Director Calif MMIS (747360)

Position Description

Medical Director careers at UnitedHealth Group are anything but ordinary. We push ourselves and each other to find smarter solutions. The result is a culture of performance that's driving the health care industry forward. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Join us. And start doing your life's best work.(sm)


This is a Medicaid Leadership opportunity in California with a proposal to support large scale projects aligned to the effective and efficient delivery of services centered on payment of fee-for-service claims, provider and member relations, drug rebate, pharmacy operations support as well as other related services necessary to support the health care delivery. Candidates must be comfortable pursuing a permanent role that is contingent on future award status with client. This is a Sr. Medical Director role to support CA Medicaid FFS membership as the MMIS vendor.


This position and the corresponding team for the above referenced opportunity will be responsible for the effective and efficient delivery of services centered on payment of fee-for-service (FFS) claims, provider and member relations, drug rebate, pharmacy operations support as well as numerous other Medi-Cal Program related services necessary to support health care delivery to as many as three (3) million Californians.

Primary Responsibilities:

  • Work to improve quality and promote evidence-based medicine
  • Operate as the principal manager in recruiting, selecting and directing the work of the medical review staff
  • Responsible for 5-7 Medical Directors directly reporting
  • Oversees all medical functions and responsibilities of this Contract, including but not limited to, participating in the development of organizational goals, ing medical policies, standards, rules and regulations of the Medi-Cal Program
  • Provides a physician face to the provider community, including but not limited to, interpreting Program regulations for medical services to medical societies and other provider groups, as well as DHCS staff involved in the joint Medical Policy Committee
  • Advises the Contractor Representative and Contractor Claims Operations staff in medical matters related to CA-MMIS Operations, changes, and medical review services
  • Facilitates participation of the professional medical staff in Program development in a collaborative manner with DHCS staff
  • Promote and communicates the mission, vision, business strategy and OPTUM value proposition to the staff through leadership meetings, educational programs and documents, program and tool development, and case discussions
  • Serve to develop, improve, and evaluate the critical thinking skills of the nurses, to achieve the highest quality and efficiency outcomes
  • Review business metrics, trend reports, utilization metrics, customer reports, and nurse and site performance metrics and presents analysis and recommends action
  • Act as a consultant to the business leaders on clinical issues related to the business model, value levers, and strategy / product / program development
  • Participate in customer and consultant presentations, participation in audits, sales, retention efforts and respond to questions related to clinical performance
  • Be “On call” for questions and issues related to utilization and medical expense reduction efforts for customers and consultants
  • Evolving the way we care for our members through the development and implementation of creative innovation of care delivery with the provider community; contributing to quality improvement activities and across our provider network
  • Communicating and marketing the Optum practice model to new members and providers as well as other stakeholders such as the medical community
  • Developing a working rapport with the medical provider network, emergency room providers, support services and others
  • Provide information on quality and efficiency to doctors, patients and customers to inform care choices and drive improvement
  • Support initiatives that enhance quality throughout our national network
  • Ensure the right service is provided at the right time for each member
  • Work with medical director teams focusing on inpatient care management, clinical coverage review, member appeals clinical review, medical claim review and provider appeals clinical review


Required Qualifications:

  • MD or DO degree

  • Active, unrestricted license to practice medicine in the State of California

  • Current board certification in ABMS or AOA specialty

  • 5+ years of clinical experience post residency

  • 2+ years of direct experience with Utilization Management

  • 5+ years of experience managing Medical Directors with progressive responsibility for the effectiveness, professional development and culture of high-performing clinicians
  • Strong understanding of and concurrence with evidence - based medicine (EBM) and managed care principles

  • Comfort working with a medically complex population
  • Excellent verbal, written, and presentation communications skills

  • 20- 25% regular travel throughout California


Preferred Qualifications:

  • Quality management experience

  • Specialty certification by the American Board of Medical Specialties Master’s Degree in Public Health Administration / Healthcare and / or completion of a course of study in a physician healthcare executives program

  • Project management or active project participation experience

  • Substantial experience in using electronic clinical systems 

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world?s large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity 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 Details

  • Contest Number747360
  • Job TitleSenior Medical Director Calif MMIS
  • Job FamilyMedical and Clinical Operations
  • Business SegmentOptumInsight

Job Location Information

    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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