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National Accounts Medical Director California Bay area

Company: UnitedHealth Group
Location: Walnut Creek
Posted on: February 14, 2021

Job Description:

National Accounts Medical Director California Bay area Compassion. It's the starting point for health care providers like you and it's what drives us every day as we put our exceptional skills together with a real feeling of caring for others. This is a place where your impact goes beyond providing care one patient at a time. Because here, every day, you're also providing leadership and contributing in ways that can affect millions for years to come. Ready for a new path? Learn more, and start doing your life's best work. SM We are currently seeking a National Accounts Medical Director in the California Bay area. The Medical Director will take a member centric approach to help the health system work better and to promote best in class care management. This includes meeting with external stakeholders, program and product design improvement, site related audits, and improvement initiatives. Primary Responsibilities: As the team's clinical leader, Medical Directors:

  • Promote and communicate 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
  • Work closely with Site Directors and Operations Product and Channel Leads to meet site, channel, and product goals
  • Serve to develop, improve, and evaluate the critical thinking skills of the nurses, to achieve the highest quality and efficiency outcomes
  • Provide leadership, training, and coaching for nurses in:
    • Clinical opportunity identification, intervention, and care plan development
    • Promotion of use of network providers, UnitedHealth Care Premium Providers, or other quality rated physicians
    • Internal partner referrals
    • Risk management and quality of care issues
    • Foster, create, and maintain a professional and respectful work environment to boost staff morale, satisfaction, retention, commitment, and engagement
    • Review business metrics, trend reports, utilization metrics, customer reports, and nurse and site performance metrics and present analysis and recommend 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, participate in audits, sales, retention efforts, and respond to questions related to clinical performance
    • "On call" for questions and issues related to utilization and medical expense reduction efforts for customers and consultants
    • Serve on project teams as a leader, participant, and/or consultant; Collaborate with internal business partners to promote value levers and other strategic initiatives
    • Work collaboratively with customers on mutually defined goals
    • Serve as a resource and a frequently requested clinical expert for outside prospects and customers by assisting the sales and account management teams with client meetings
    • Support community activities that enhance Community Relations and Reputation As a Case Reviewer, Medical Directors:
      • Perform peer to peer discussions when indicated which promote optimal health and well-being of the individual
      • Through one-on-one discussions as well as Medical Director Value Case Reviews with nursing staff, stimulate critical thinking, assist in identification of clinical gaps, and coach staff on communication with providers and on care plan development
      • Direct coordination and management of complex care issues in conjunction with enrollees' physicians and proposes care plans to prevent readmissions
      • Encourage the principles of "6C" call conduct, Inductive Call Anatomy, warm and engaging consumer interaction, call efficiency, good case management principles, and focus on measurable outcomes
      • In conjunction with Clinical Managers, work to improve the nurse knowledge base and management of cases through site leadership meetings, clinical teaching sessions, team meetings, case audits, nurse tools, and one-on-one case discussions
      • Adhere to medical director performance metrics and evaluations
      • Knowledge of admission, readmission data, and overall medical expense that would drive changes in focus at the case level
      • Alert UHC Medical Directors to provider issues of compliance with UHC protocols, over utilization, quality of care issues, and lack of adherence to EBM guidelines
      • Support quality reviews, inter-rater reliability sessions, regulatory requirements, and accreditation and certification efforts including performing audits and participating in quality clinical improvement studies As a "Physician Liaison," Medical Directors:
        • Interact with Regions, Markets, Customers, and other UHG Medical Directors, Sales, Account Management, Clinical Solutioning, Health Plan Medical Directors, Network Management, and OptumHealth partners to implement strategy implement products and programs, acquire and retain customers, and improve the quality and outcomes of the consumers navigating care delivered by the provider network and to improve relationships between the organizations
        • Attend Monthly Medical Expense Meetings by Region and assist with regionally based Affordability Initiatives with a focus on admission, readmission, and overall bed day management
        • Understand and act upon Condition Specific drivers including high cost claimants and consumers with a pattern of frequent utilization
        • Must be willing to work in the office as needed; however will allow to work remotely several days per week You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications:--
          • MD or DO with an active, unrestricted medical license in the state of California
          • Current Board Certification in an ABMS or AOBMS specialty
          • 3+ years of clinical practice experience post residency
          • Excellent written and oral communication skills with customer facing experience
          • Excellent project management skills
          • Solid data analysis and interpretation skills; Ability to focus on key metrics
          • Proficiency with Microsoft--Office applications
          • You will be provisioned with appropriate Personal Protective Equipment (PPE) and are required to perform this role with patients and members on site, as this is an essential function of this role
          • Employees are required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener prior to entering the work site each day, in order to keep our work sites safe. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained. Preferred Qualifications:--
            • Board certification in Internal Medicine or Family Medicine
            • 2+ years of managed care experience, including UM, CM, Affordability / Cost savings initiatives, Quality Management experience, and/or administrative leadership experience Careers with Optum.--Here's the idea. We built an entire organization around one giant objective; make the health system 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) *All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy. 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, Board Certified, Clinical Practice, Claims, Utilization Management, Managed Care, Bay Area, CA, California, Telecommute, Remote Business Segment Enterprise Clinical Services Our team members help close the gap in health care. Take a closer look and see how Lisa helps members navigate a complex health care system. We're committed to diversity and inclusion in everything we do. It's ultimately what helps us understand a variety of perspectives and provide quality care to our diverse member population. If you're interested in working for an organization that val--- A Nursing career at UnitedHealth Group can be challenging, yet very rewarding at the same time. Our Registered Nurses and Nurse Practitioners are caregivers through and through. At UnitedHealth Group, they work in a fast-paced environment directly wi--- At UnitedHealth Group we utilize many avenues to find the right candidates to fill open positions. One of which, involves asking our current employees to refer the people they know that would be a good fit for the company. Our employees have great in--- UnitedHealth Group is committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities. If you need special assistance or accommodation for any part of the application process, please call 1-800-561-0861 and press or say 1 for Applicant to be connected to Recruitment Services. Recruitment Services hours of operation are 7 a.m. to 7 p.m. CT, Monday through Friday. UnitedHealth Group is a registered service mark of UnitedHealth Group, Inc. The UnitedHealth Group name with the dimensional logo, as well as the dimensional logo alone, are both service marks for the UnitedHealth Group, Inc. 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.

Keywords: UnitedHealth Group, Walnut Creek , National Accounts Medical Director California Bay area, Executive , Walnut Creek, California

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