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Natl Medical Director Clin Performance, Decision Support
AFTON MN 55001
Category: Health Care Industry , Insurance
  • Your pay will be discussed at your interview

Job code: lhw-e0-90671511

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UnitedHealth Group

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  Job posted:   Thu Jun 7, 2018
  Distance to work:   ? miles
       
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Natl Medical Director Clin Performance, Decision Support
If you want to achieve more in your mission of health care, you have to be really smart about the business of health care.
Challenge yourself, your peers and our industry by shaping what health care looks like and doing your life's best work.(sm) Enterprise Clinical Performance is charged with effectively designing, implementing, monitoring, and executing on clinical affordability programs and projects chartered with improving quality of care and achieving best in class clinical outcomes for our patients while reducing overall costs across providers within OptumCare.
OptumCare is a ~ $9 billion a year organization, touching over 9 million patients, 80 payers and 22,000 providers.
Enterprise Clinical Performance provides support to all markets served by OptumCare.
The National Medical Director will report to the SVP, Enterprise Clinical Performance, OptumCare and will be responsible for leveraging Evidence Based Medicine guidelines to drive strategic direction, design, development and execution of programs focused on elimination of avoidable and wasted care while improving clinical outcomes and patient and provider satisfaction.
This includes applicability across all in scope organ systems (e.g., ortho, cardiology, GI, urology, oncology, endocrine, pulmonary, women's health, neurology, dermatology, ENT, Nephrology), across all line of business, in diverse local markets, while preserving local market uniqueness and relationships. The role will be partnered with a Senior Medical Director and together, with the support of the Clinical Performance team, will drive results.
It will have no direct reports but may provide indirect work direction and guidance to other employees.
Primary Responsibilities: The National Medical Director must be a deep subject matter expert who can drive execution and change through collaboration and relationships The primary responsibilities include leveraging Evidence Based Medicine guidelines to drive strategic direction, design, development and execution focused on elimination of avoidable and wasted care while maintaining or improving clinical outcomes.
This includes applicability across organ systems (e.g., ortho, cardiology, GI, urology, oncology, endocrine, pulmonary, women's health, neurology, dermatology, ENT, Nephrology), across all line of business, in diverse local markets, while preserving local market uniqueness and relationship Provide clinical direction and leadership from strategy through production implementation and continuous process improvement for the end-to-end program (e.g., provider and specialist education / training, PCP report cards, ROI dashboard, staffing model, referral management, POC prompts, operations) driving elimination of avoidable and wasted care Provide long term planning and oversight assuring activities are appropriately integrated into strategic direction, as well as the mission and values of the company.
This also involves selection and expansion of best practices while simultaneously striving for standardization and driving performance Provide direction and leadership to define (e.g., leading and lagging indicators), design and implement reporting and processes to track, report and monitor forecasted vs actual medical expense reduction targets by program and by Care Delivery Organization.
Where actuals are not aligned with forecasts, take rapid action to revise strategies, tactics and interventions to achieve utilization and financial results Given the complex nature of OptumCare, the ability to achieve goals through a combination of direct and indirect influence will be critical Lead through influence the medical leadership of varying businesses and their corresponding hierarchies (totaling approximately 12) across the country with expectations to grow over time Direct the design and delivery of extremely complex business solutions within the Enterprise Clinical Performance team and across multiple cross-matrixed teams Provide leadership and direction in lowering the cost of care Take full accountability for patient outcomes, patient and provider satisfaction and financial results Assist in increasing collaboration and driving results with the OptumCare Care Delivery Organizations Coordinate inter-Care Delivery Organization discussions to leverage knowledge and learnings and share best practices Partnering with Healthcare Economics and Enterprise Clinical Performance, provide clinical input (e.g., ICD diagnosis codes, CPT / HCPCS codes) and direction for inclusion to support robust data and opportunity analysis Interface with Healthcare Economics and Enterprise Clinical Performance teams to identify, size, review and prioritize opportunities Analyze and convey a deep understanding of data insights and use of standard benchmarks Support overall regional and corporate goals to ensure continued growth and profitability Participate in acquisition due diligence and new market expansions Align with national standards and medical expectations as they relate to eliminating avoidable and wasted care Provide medical leadership for the Clinical Affordability team chartered with improving the quality of care and achieving best in class clinical outcomes for our patients while reducing overall costs across providers within OptumCare Provide clinical expertise for the development of solid Cost Benefit Analysis (CBAs), staffing models and Operations support documentation (e.g., work flows, P&Ps, SOPs) for assigned initiatives Continually seek to identify incremental medical expense reduction opportunities and pursue approvals and buy in where there is a robust business case Encourage building strong collaborative relationships with leadership and medical management resources in the Care Delivery Organizations and key partners throughout the organization.
Promote understanding of Evidence Based Medicine, clinical best practices, market trends and patient and provider needs related to care delivery, medical management and clinical affordability Promote an environment of understanding of the market nuances to drive cross functional team synergy Build strong relationships and a broad knowledge base across the UHG organization Ensure compliance with all requirements (e.g., CMS, NCQA, Health Plan, state) Required Qualifications: M.D.
Board Certified in a post graduate clinical specialty; internal medicine, geriatrician, general surgery or Primary Care preferred; Un-restricted Licensed to practice medicine in any state M.B.A or M.P.H 15+ years' experience in the healthcare industry in a medical administrative role (work in the payer and provider fields both a plus) 15+ years' experience working in UM/DM/CM or related fields Familiarity with the following is key : Medicare, Commercial and Medicaid benchmark and trend data; Medicare regulations with respect to inpatient and SNF management. Cost of care metrics; Payment methodologies including fee for service (CMS-1500, CMS UB 04);Broad and comprehensive knowledge of the care of patients in outpatient care settings including but not limited to Clinics, Ambulatory Surgery, Procedure labs, etc. Health plan finance reporting; care models and staffing models Solid understanding of managed care systems, quality improvement and risk management Demonstrated ability to lead decision support programs Proven ability to develop strategies, plans, tactics and interventions and partner with technology organizations for implementation Demonstrated ability to work in a highly matrixed organization Knowledgeable on delegation in managed care and on how to establish newly delegated entities Strong interpersonal skills and ability to build relationships Excellent presentation, writing, and negotiation skills Outstanding organizational skills Strong consulting skills Ability to influence others Proven ability to work with people at multiple levels of the organization, multiple functions of an organization, and multiple locations Demonstrated leadership skills Willingness to travel up to 50% as determined by business need 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) 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. 664a913f-1a34-421d-861e-33497b81c5fe
*Natl Medical Director Clin Performance, Decision Support*
*Minnesota*
*765910*

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