10 days old

IPA Medical Director - Golden, CO

Golden, CO 80401
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  • Job Code
    878415

You're looking for something bigger for your career. How about inventing the future of health care? UnitedHealthcare is offering an innovative new standard for care management. We're pushing ourselves and each other to find smarter solutions. The result is a culture of performance that's driving the health care industry forward. As a Medical Director you will use your talents to take our already-exceptional service and innovation to the next level. You will lead a team of world-class professionals who are removing barriers to better health with every new idea. Ready for a new path? Join us and start doing your life's best work.(sm)

 

Optum is the largest network of health care providers in the United States, whose mission is to connect and support providers by working together to deliver the most effective and compassionate care to each and every patient they serve.  Optum's focus is to do the right things for patients, physicians, and the community. Optum's Core Business is contracting directly with health insurers to deliver a highly personal care management and service model to their patients.  A main focus of Optum is on seniors, and those with complex care needs, who most benefit from a high touch model of care.

 

The IPA Medical Director in CO will report to the Chief Medical Officer (CMO).  The IPA Medical Director will assist the CMO in directing the clinical strategy in the market to support and enable Independent Practice Affiliate Physician Offices of Optum to enhance the delivery of care in a value based population health care environment.  This individual will work to build strong, trusted relationships with other providers to influence and change behavior in a collaborative way. The Medical Director will be required to work cross-functionally and will be expected to provide insight and perspective from the network point of view to the CMO and leadership team. They will support the CMO with utilization management (UM), prior authorization determinations, oversight and direction of inpatient and skilled nursing facility utilization, oversight and direction of Outpatient Care Management Services, Medicare Risk Adjustment Factor (RAF) education as well as HEDIS/STARS education, and provider/group relationship building.  This individual may be meeting with providers in the care delivery setting and will work with them and the CMO to identify opportunity for improvement in clinical documentation, coding and effective utilization.

 
Primary Responsibilities:
  • Strategic leadership over the Independent Practice Affiliate Program in Colorado
  • Apply understanding of patient care quality metrics to enhance clinical outcomes (e.g., HEDIS; 5 STAR; disease-based metrics) in order to drive/achieve quality outcomes
  • Supporting all clinical quality initiatives and peer review processes
  • Effectively engaging and bringing understanding to our external constituents such as physicians, medical and specialty societies, hospitals and hospital associations, and state regulators
  • Identifying opportunities through participation in local medical expense committees or market reviews
  • Provide assistance in appeals review where appropriate
  • Assist in RAF/HEDIS/STARS education to improve metrics
  • Leading and building the team responsible of oversight of the HEDIS data collection process, CAHPS (Consumer Assessment of Healthcare Providers and Systems) improvement, and drive Health Plan accreditation activities

You'll 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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Posted: 2020-06-25 Expires: 2020-07-25

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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IPA Medical Director - Golden, CO

UnitedHealth Group
Golden, CO 80401

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