CMO - United HealthCare - Community Plan - Michigan
March 10, 2018
Looking for a chance to drive measurable and meaningful improvement in the use of evidence-based medicine, patient safety, practice variation and affordability? You can make a difference at UnitedHealth Group and our family of businesses in serving our Medicare, Medicaid and commercial members and plan sponsors. Be part of changing the way health care is delivered while working with a Fortune 6 industry leader. MD with Michigan license extensive experience in managed care, with a preference for Medicaid experience Primary Responsibilities:Provides clinical leadership to the Health Plan quality team and is accountable for managing outcomes of the team Collaborates with the RCMO, ICCT team and other clinical staff to establish and implement clinical programs to support and meet the UM goals Conducts Medical Director activities primarily focus on support of the daily review activities and external interaction and communication with network physicians Oversee daily and on - going over site of clinical reviews and evaluation of clinical care and services provided to plan members Interacts, communicates, and collaborates with network and community physicians, hospital leaders, and other vendors regarding clinical care and services for enrollees. Facilities and uses performance data to guide interactions Oversees provider telephonic review and discussion, and shares tools, information and guidelines related to quality, cost - effective health care delivery and quality of care Over sees peer - to - peer dialogue to review issues, develop collaborative intervention plans and share ideas about network management issues Meets all targeted benchmarks Over sees documentation of case review findings, actions, and outcomes in accordance with policies; meets health plan inter-rater reliability guidelines Over sees daily conferences (rounding) with ICCT team to identify delays in care, facilitate discharge planning, and develop follow up action to address care coordination issues Is available and accessible to the Medical Directors and ICCT team throughout the day to respond to clinical issuesServes as a clinical resource, coach, and leader for Health Plan Clinical team Shares best practices with other medical directors and clinical leaders from other regional sites Directs weekly team meetings and rounds for communication, feedback, problem solving, staff training and development and sharing of program results Facilitates access to clinical specialty panel physicians to assist in complex or difficult cases Develop and monitors utilization reports by product line, identifying changes in utilization or access patterns and monitor overall trends on a weekly basis Interacts with RCM to develop HCQAI plans and to implement strategic initiatives and tactics to address areas of concern and monitors progress towards goalsInteracts with RCMO to ensure coordinated approach to delivery system providers Participates in design and development of care programs and national committee's requested
Required Qualifications:Current and non - restricted licensed physician; Board Certified in ABMS specialty 5+ years post - licensure experience as a senior clinician and leader with responsibility for clinical standards, quality management, and clinical supervision in a health plan organization 5+ years experience in Medicaid / Medicare government programs or Medicare fee for services Demonstrated accomplishments in the areas of medical care delivery systems, utilization management, quality management, and peer review Strong operational focus with demonstrated data analysis / interpretation acumen, project management, change management, and execution skills Self-motivated and able to work with little direct supervision and drive results with disciplined follow - though Strong strategic thinking and business acumen with the ability to align clinical related strategies and recommendations with business objectives Adaptable and flexible style of collaborating with key stakeholders in setting direction Proven ability to quickly gain credibility, influence and partner with employees, business leaders and the clinical community High integrity with a reputation of a trusted confidential advisor and partner Visibility and involvement in medical community Ability to develop relationships with network and community physicians and other providers Excellent presentation skills for both clinical and non clinical audiencesCareers at UnitedHealthcare Community & State. 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. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place 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. In addition, employees in certain positions are subject to random drug testing.
Internal Number: 745893
About UnitedHealth Group
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.