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. Bring your skills and talents to a role where you'll have the opportunity to make an impact on a huge scale. This is the place to do your life's best work.(sm) The Specialist Physician Leader is responsible for the development, implementation , effectiveness and transition of payment from Fee for Service to Fee for Value of the WellMed Specialty Network for DFW; ensures provision of quality health care services in the most efficient and cost effective manner. Oversees the medical management of the network and offers guidance to providers in the delivery of healthcare for the Medicare Advantage population. Assists in implementing contracts and developing surgery centers in efforts to provide patients with a demographically efficient network with a collection of multi-specialties who will provide quality medical care. Primary Responsibilities:Develops and maintains an efficient Physician Specialty Network to meet the needs of the health plan members and commensurate with company valuesEducates specialty physicians regarding systems, structures, processes and outcomes necessary for assurance of regulatory compliance Develops strategies for improving performance in medical managementDevelops strategies for improving performance in coding accuracy and Star Quality measuresLiaisons between specialty physicians and health plan Medical DirectorsImproves relationships with both contracted and employed specialists by developing fee for value contracting arrangements with the major specialties used in Medicare Advantage patient populationsDisseminates and communicates market and enterprise strategies to the various employed and contracted specialistsManages the operations of employed and contracted specialists, including but not limited to, scheduling, productivity, and compensationNavigates the relationship between the employed specialists and their employed primary care counterpartsAssists in planning and implementing capitated contracts with various specialties, including: Orthopedics, Cardiology, Urology and other specialties that may be required in the various markets where WellMed, and its affiliates, have MA membersAssists in development and implementation of surgery center and ancillary services strategy for employed and contracted physiciansDevelops closer relationships with contracted primary care physicians, improving the fee for value proposition and development and implementation of multiple business line relationshipsAssesses the effectiveness of the specialty network to ensure members have access to multi-specialties within their demographic arePerforms all other related duties as assigned QualitySeeks ways to improve job efficiency and makes suggestions to improve operations that meet national standards as well as company needsProvides constructive information to minimize problems and increase customer satisfactionActs as a resource to physicians on benefits, medical criteria, and contract negotiations Customer ServiceEvaluates performance of physicians in regards to established company goals and objectives Performs duties with physicians and medical group staff in a professional and responsible mannerResponds to physicians in a prompt, pleasant and professional manner Respects physician, patient, and organizational confidentialityEducates medical groups regarding policies, procedures and government-mandated regulations.Personal and Physician DevelopmentStrives to nurture and expand working relationships within the NetworkAttends and contributes to physician meetingsOrients new physicians to the Network to ensure understanding of company policy and resources available for physician supportEncourages teamwork and cooperation with medical group staffs Attends continuing education classes to keep abreast of medical advancements and innovative practice guidelines
Required Qualifications:Doctor of Medicine (M.D.) degree Board Certified in a medical or surgical specialty Texas Licensed Medical Physician or Doctor of Osteopathy Five or more years of clinical practice experience Five or more years of experience in Medicare Advantage patients population activities Five or more years of network development and contract negotiations Possess planning, organizing, conflict resolution, negotiating and interpersonal skillsIndependent problem identification / resolution and decision making skills Ability to interact productively with individuals and with multidisciplinary teamProvide leadership for the Network to assist in complex cases needing intervention of experienced counsel Preferred Qualifications:5-7 years Medicare Advantage plan experience as a Medical DirectorCareers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 90,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team 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 Keywords: Specialist, Physician, Leader, certified, licensed, Medical, Director, Medicare, Advantage, Wellmed, Texas
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.