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Associate Medical Director, NAMM Optum - Ontario, CA

Company: UnitedHealth Group
Location: San Bernardino
Posted on: June 18, 2022

Job Description:

Life Changing WorkWant to make a real difference in the lives you touch? LOOK NO FURTHER. Optum is a physician-led, close-knit team that has been long-respected in Southern California. We are passionate about patients. We are leading the state of California toward better healthcare practices. And we are looking for amazing Clinicians like you. As part of our continued growth we have new opportunity for Associate Medical Director to join our leadership team based in San Bernardino County. Overview: Collaborate with Physicians and IPA teams to ensure that patient needs responsible for many Medical Management functions including but not limited to provider relations, Utilization Management and Quality Management functions. Assist with oversight and development for major programs and functional areas within an IPA setting including medical policy review and development; patient centered medical home oversight, population management, and reporting functions. Work with Physicians and other providers, especially PCMH practices, to improve the quality, affordability, and member satisfaction to achieve the Quadruple Aim. Primary Responsibilities:

  • Works primarily with the physician community around issues of patients, balancing business, and clinical concerns
  • Provides limited utilization management for outpatient medical, surgical and pharmacy activity. Participates in medical appeals activity. Work with the Appeals unit on appeals related to utilization management issues
  • Provides medical leadership and physician advice to the quality management area with respect to quality improvement studies, quality improvement committees, primary care assessments.
  • Performs peer reviews on quality complaints, sentinel events, and quality-of-care referrals --- Serves as Physician Advisor for other areas within the company, including but not limited to Sales and Marketing, Underwriting, PHP, and Provider Services.
  • Provides medical leadership and advice for conformance with standards and guidelines for NCQA, URAC, state and federal regulators, and other accrediting bodies. Acts as liaison for communication with physicians, hospitals, and other providers in the community.
  • Act as the Clinical Lead for Risk Adjustment and works collaboratively with the Risk Adjustment team and IPA leadership and physicians to improve the accuracy and completeness of coding and documentation (approximately 50- 60% dedicated time for risk adjustment efforts).
  • Collaborates and engages with the IPA physicians and practices to implement strategies to improve the completion rate of annual wellness visits. Collaborates with the Quality team and IPA physicians and practices to implement strategies to improve Quality STARs measures.
  • Participates in affordability strategies to include inpatient management, outpatient high risk management, site of service and specialty contracting opportunities. Assist with coverage of Medical Directors in areas of review and IDTC conference management as needed.We offer a competitive salary, bonus plan and comprehensive benefit package including medical malpractice coverage, CME time and dollars, medical, dental and vision benefits, company paid life insurance, available supplemental insurance plans and 401K plan.Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance. Required Qualifications:
    • Possess a current and unrestricted MD or DO license in California
    • 3 or more years of experience working as a Medical Director in a managed care setting
    • 3 or more years of experience in utilization management, utilization review and prior authorization
    • 3 or more years of experience interacting with both group and IPA Physicians
    • Experience with inpatient/hospitalist management
    • Experience with and comfort level in supervising Advanced Practice Clinicians
    • Board certification in their chosen specialty
    • If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders
    • Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliancePreferred Qualifications:
      • Prior experience working with clinical information technology systems
      • Public presentation skills What's the first thing that happens when one of the most successful groups in Riverside County comes together with a global leader in health care? Opportunity. With NAMM joining OptumCare and the UnitedHealth Group family of companies, people like you will find increasing levels of challenge, impact and professional success. With a vibrant network of hospitals and urgent care centers, we're changing health care for the better by improving access to affordable, high quality care, and working together to improve the patient experience. That takes passion, commitment, intense focus and the ability to contribute effectively in a highly collaborative team environment. Are you with us? Learn more about this exciting 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: Medical Director, MD, DO, managed care, UM, Utilization Management, CM, Case Management, IPA, clinical informatics, Ontario, Riverside, San Bernardino, San Diego, CA, Telecommute

Keywords: UnitedHealth Group, San Bernardino , Associate Medical Director, NAMM Optum - Ontario, CA, Executive , San Bernardino, California

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