Medical Director Network Performance –Albuquerque New Mexico
Overview of Position:
The Medical Director will partner with 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 clinicians 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 work with 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 will be meeting with clinicians 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. Frequent travel within the metropolitan area is expected.
Required: Fully licensed as a physician in the state of New Mexico.
Preferred: Master’s Degree in related filed
Required: Two (2) years’ experience at senior leadership level in medical group or network; Five (5) years’ experience as a practicing physician preferably in a medical group.
Preferred: Experience in both fee-for-service and managed care operations. Experience and knowledge of Medicare Advantage programs (STARS, RAF, HEDIS, CHAPS/HOS etc). Experience with identifying Medicare risk adjustment and presenting findings to client/clinicians
Knowledge, Skills, Abilities:
Thorough understanding of medical group business models and clinical processes.
Ability to strategically lead regionally to ensure accurate diagnostic codes in order to maximize risk adjustment (RAF).
Experience with identifying Medicare risk adjustment and presenting findings to client/clinicians; Working knowledge of managed care and value based medicine
Excellent understanding of medical group financial concepts, including revenue cycle, physician compensation models, and preferably including managed care financial concepts (capitation, IBNR, MLR).
Helping set agendas/strategies and leading multifaceted teams of Physician Business Managers, Risk Adjustment dyads, and Quality partners.
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. 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. Here you’ll find incredible ideas in one incredible company and a singular opportunity to do your life's best work.(SM)
Diversity creates a healthier atmosphere: Optum and its affiliated medical practices are Equal Employment Opportunity/Affirmative Action employers 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. Optum and its affiliated medical practices is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.