1+ months

National Accounts Medical Director Atlanta GA

Atlanta, GA 30303
  • Job Code
    879090

Medical Director careers at UnitedHealth Group are anything but ordinary. We push ourselves and each other to find smarter solutions. The result is a culture of performance that's driving the health care industry forward. Instead of seeing one patient at a time, you have the opportunity to impact health care trend across the population with data driven information and tools to drive evidence based care. Join us. And start doing your life's best work.(sm)

 

We are currently seeking a National Accounts Medical Director to sit in our Atlanta, GA office. The Medical Director will take a member centric approach to help the health system work better and to promote best in class care management. This includes meeting with external stakeholders, program and product design improvement, site related audits and improvement initiatives.    

 

This role has three core functions:

As the team's clinical leader, Medical Directors:

Promote and communicates the mission, vision, business strategy and OPTUM value proposition to the staff through leadership meetings, educational programs and documents, program and tool development, and case discussions.

  • Work closely with Site Directors and Operations Product and Channel Leads to meet site, channel, and product goals.
  • Provide leadership, training and coaching for nurses in:

As Case Reviewer, Medical Directors:

  • Perform peer to peer discussions when indicated which promote optimal health and well-being of the individual.
  • Through one-on-one discussions as well as Medical Director Value Case Reviews with nursing staff, stimulates critical thinking, assists in identification of clinical gaps, and coach staff on communication with providers and on care plan development;

As -Physician Liaison-, Medical Directors:

  • Interact with Regions, Markets, Customers, and other UHG Medical Directors, Sales, Account Management, Clinical Solutioning, Health Plan Medical Directors, Network Management, and OptumHealth partners to implement strategy implement products and programs, acquire and retain customers, and improve the quality and outcomes of the consumers navigating care delivered by the provider network and to improve relationships between the organizations.
  • Attend Monthly Medical Expense Meetings by Region and assist with regionally based Affordability Initiatives with a focus on admission, readmission overall bed day management
  • Understand and act upon Condition Specific drivers including high cost claimants and consumers with a pattern of frequent utilization

Responsibilities:

  • MD Lead of is an integrated comprehensive clinical model
  • Daily BCRT rounds; integration with Optum RX, Briova, Behavioral, CCR, ICM and Advocates
  • Customer Specific Predictive Model with new ID Strat Rules. (Hub Rules)
  • Support Leadership visits to the Hub throughout the year
  • Support for RFP's
  • Customer Specific VDA report, access to HCTA, PBC reporting, Hospital Cost Report for analyzing trends and calculating savings
  • Automation projects for the Hub include Shewart Charting (Control Charts), BCRT Extract Tool and Proactive Outreach by CIDM for Denials Tool and Process
  • To-date Savings Calculations for the Hub
  • Managing Catastrophic Claimants
  • Coordination of Benefits
  • Subrogation coordination
  • Address escalated issues from the customer's HR and benefits team
  • Assist with benefit design
  • Individual Case Review and Peer to Peer and Peer to Consumer calls as needed
  • Alignment of the customer's culture with Our United Culture across the Hub
  • Ensure benefit determinations are consistent with plan desires and are consumer centric
  • Manage to trend guarantee
  • Participate in larger quarterly MCAP activities and drive the Small Group MCAP for customer specific savings or process improvement opportunities
  • Compile and compose success stories
  • Cascade learnings to other teams through the value story and playbooks
  • Support for the Special Needs Initiative

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: 2020-06-29 Expires: 2020-08-28

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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National Accounts Medical Director Atlanta GA

UnitedHealth Group
Atlanta, GA 30303

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