1+ months

Chief Medical Officer - Medical Management - Colorado Springs, CO - 927389

Colorado Springs, CO 80903
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  • Job Code
    927389

The Chief Medical Director/CMO Medical Management provides leadership for the system of medical management in facilities, home care, palliative and hospice and special programs ensuring appropriate decisions are made that are in alignment with health plans utilization management. Influences multiple areas to ensure clinical business performance on the management of its patient populations are meeting quality standards. This position will provide oversight and implement programs with the clinical business and network hospitalist groups regarding medical management processes. Assist clinical operations to educate providers and clinical staff on operating procedures for both inpatient and preservice decision including the use of Medicare, Medicaid, Health Plans and Milliman guidelines, observation processes and medical management principles to promote positive utilization outcomes. Ensures the development of clinical transitional processes for patient care to the post-acute system and then works towards maximizing those transitions with clinical practices/network/IPA primary and specialist care. Ensures that clinical and case management staff executes utilization practices and effectively using appropriate resource management.

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Primary Responsibilities:

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  • Manages clinical and operational staff in the process of medical management of assigned lines of business
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  • Guides medical directors and nurses in all aspects of medical care and multi-level transitions of care
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  • Supports inpatient case review and is accountable for successful bed day management that meets established company goals
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  • Analyses utilization data to identify trends and opportunities for process improvement related to medical management (inpatient and outpatient) activities
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  • Sets annual medical management plans to meet the overall regional and corporate goals to ensure continued growth and profitability of the Medical group
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  • Participates in senior medical management strategy development and implementation to ensure that appropriate care and services provided to members meet best practice standards as well as regulatory compliance requirements
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  • Directs operational team towards education plans for physicians and nurses in effective management of patients benefits and medical services that meet the needs of the members and utilizes resources appropriately
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  • Works with the other Senior Medical Directors and Chiefs to educate on processes, principles and operating procedures for medical management initiatives
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  • Develops professional relationships with network providers, providers and all appropriate facilities to act as liaison between these groups and engage in problem or conflict resolution as necessary
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  • Evaluates the medical criteria protocols and used by medical management to ensure that the business is aligned with national standards
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  • Ensures that operating practices are in compliance with United Compliance standards
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  • Advises direct reports towards utilization trends, medical management programs and educational opportunities holding each accountable for the overall positive medical management outcomes
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Youll 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.
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Required Qualifications:

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  • MD or DO
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  • Board Certified in a postgraduate clinical specialty
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  • Active and unrestricted license issued by the State Board of Medical Examiners
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  • Training in medical management
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  • Knowledge of Medicare coverage criteria
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  • 10+ years of medical experience
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  • 8+ years of progressively responsible management experience preferably in a managed care setting
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  • Broad and comprehensive knowledge of medical management principles and insurance products for multiple and varied lines of business in a managed care environment
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  • Strong knowledge of the community health care environment, the provider network and the managed care contracting processes
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  • Good understanding of managed care systems, quality improvement and risk management
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  • 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.
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Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care 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)

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The salary range for Colorado residents is $130,300.00 to $250,200.00. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.

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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.

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UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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"Job Keywords: senior medical director, chief medical officer, medical management, Colorado Springs, CO, Colorado
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Posted: 2021-04-24 Expires: 2021-06-23

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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Chief Medical Officer - Medical Management - Colorado Springs, CO - 927389

UnitedHealth Group
Colorado Springs, CO 80903

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