1+ months

Chief Medical Officer, NAMM Optum - Ontario, CA

Ontario, CA 91764
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  • Job Code
    806776

We at NAMM, a part of OptumCare, deliver a clearly differentiated level of outcome and service adherence. Come join our team and add to our bench strength as we execute on managed care 2.0 bringing together revenue optimization, appropriate utilization, unit cost management and strategic acquisitions. Quality care saves money without exception.

 

As a part of our growth, we are searching for a new Chief Medical Officer to join our organization.

The Chief Medical Officer has primary responsibility for the clinical oversight and medical management of the physician networks managed by PrimeCare Medical Networks Inc (PMNI). The CMO ensures that the care delivered by participating physicians and providers meet the standard for quality, timeliness, and appropriateness.  The CMO represents PMNI to the health plans for issues related to UM, QI, Credentials, and other related provider performance issues. 

 
Primary Responsibilities:
  • Oversees and supervises PMNI UM staff and activities in all areas including acute hospital and ambulatory settings
  • Works directly with IPA Medical Directors and utilization management staff to ensure appropriate patient access to care, care meets consistent standards for quality, and that there is cost effective resource utilization
  • Works with Executive Directors and physician leaders to utilize reported utilization and performance information to identify opportunities to improve care, service and cost-effectiveness for all providers including vendors
  • Actively leads the medical directors and clinical staff to gain UM improvements in each network
  • Works directly with IPA medical directors and quality improvement staff to ensure an effective QI program that actively ensures quality care and service
  • Ensures that the QI program incorporates all NCQA, HMO, and other applicable requirements
  • Oversees and supervises provider credentialing activities. Ensures that all standards and requirements are met
  • Presides over the PMNI Credentials Meetings
  • Teams with local and regional administrators to increase network size, enrollment, and revenues; and to manage clinical and administrative cost
  • Works with administrators to define business goals for each network and leads in the engagement of physician leaders to accomplish them
  • Physician leadership development
  • Work cooperatively with and actively support PMNI Compliance Program
  • Support Finance and Accounting, and Provider and Plan contracting 
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Posted: 2019-08-16 Expires: 2019-10-19

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, NAMM Optum - Ontario, CA

UnitedHealth Group
Ontario, CA 91764

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