Optum Serve Medical Director - VA Community Care Network - Remote in US

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Optum Serve is part of the family of companies that make UnitedHealth Group, one of the leaders across the US healthcare system.  Optum Community Care Services (CCS) sits within Optum Serve supporting federal contracts such as the Veterans Administration Community Care Network (VA CCN) which provides a network of community care providers to serve Veterans.

The Optum Community Care Services (CCS) Medical Director works diligently to oversee clinical quality provided from community care providers to Veterans. The medical director will work collaboratively with the Patient Safety Specialists in reviewing medical records and determining applicable standards of care. The medical director will Chair the Med/Surg Peer Review Committee and oversee that the Peer Review Committee meets all applicable regulations and legal requirements. The medical director will facilitate and/or attend other committees including the Clinical Quality Improvement Program Committee.

The Medical Director will be accountable for ensuring that initiatives focused on clinical excellence and CCS clinical quality program requirements are implemented and successfully managed to achieve performance expectations and meet all contractual requirements. The medial director will perform clinical quality reviews of medical/surgical care, program integrity reviews involving regulatory compliance, health care delivery, and other functions to ensure that the best quality of care is provided to Veterans who are community care beneficiaries.  This position requires working collaboratively and closely with internal and external partners. The medical director is expected to always communicate effectively and professionally with internal and external partners including the clients. Utilization management on such tasks as concurrent review and prior authorization review may be required in future contracts.

This position reports to the Chief Medical Officer, Community Care Services.

The Medical Director also provides leadership to clinical staff through case consultation and case reviews and regularly updates the Chief Medical Officer, CCS. The Medical Director will provide to the Chief Medical Officer, CCS recommendations for clinical quality program process improvements. The Medical Director is accountable for managing resource allocation as is applicable to medical management practices under his or her scope of responsibility.  The Medical Director will consult with Optum Serve Technology and Consulting Solutions as needed on CMS and other Federal health Market consulting RFIs, RFPs, and contracts for VA Community Care Network and will support the Chief Medical Officer, CCS on various committees as necessary.  

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Clinical leadership within Optum Serve and reports to the Chief Medical Officer, Community Care Services.  They collaborate with the CEO, Community Care Services which has responsibility for VA CCN
• Develops, coordinates, and participates in clinical quality program design, development, implementation, oversight, and monitoring as a medical leader within the Optum Serve team
• Works collaboratively with the Chief Medical Director, CCS and the CCS leadership team in the development and Implementation of clinical quality management and cost initiatives (Value Based Care) and medical management program development
• Works with the Clinical Quality team with patient safety managers, patient safety specialists, the dental director, the behavioral health director, and other internal partners to ensure adherence to clinical quality performance standards
• For future contracts, the Medical Director may support whole person care (M/S and BH case and disease management) utilization management and program integrity
• Provides for and recommends clinical program enhancements and quality improvements that adhere to the VACCN requirements and reflect emerging clinical solutions and best evidence-based practices
• Provides clinical education to clinical staff to ensure VACCN clinical quality program success
• Accountabilities include oversight of VACCN clinical processes with a focus on Implementing plans of care that meet accepted guidelines and protocols and ensure that optimal and appropriate clinical services are provided
• Ensures compliance with all policies, procedures, bylaws, regulatory requirements, and best practice guidelines
• Participates in the continued implementation and any process improvements of the VACCN clinical quality program
• Oversees evaluation and management of medical practices within the requirements of Med/Surg Peer Review Committee
• Recruits and maintains participation of external actively practicing providers and manages the Independent Review Organizations (IRO) for specialty review when required
• Ensures consistent and continual monitoring of quality of care delivered
• Provides recommendations on measures as established within VACCN and other quality metrics such as Hospital Compare, HAC, and AHRQ set by the VA and Optum Serve
• Reviews completed charts on a regular and timely basis in preparation for Peer Review Committee activities
• Provides and receives consistent feedback on the clinical quality of care being delivered
• Assists where applicable on RFI, RFP, contracts at Optum Serve Consulting and assisting with future growth opportunities
• Other duties as assigned to support Clinical Quality, CCS and the enterprise

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.

Required Qualifications:

• MD or DO with an active, unrestricted license
• Current board certification with Internal Medicine or Family Medicine, Surgery, Physiatry or Emergency Medicine preferred
• 5+ years of clinical practice experience
• Demonstrated familiarity with current medical issues and practices
• Proficient understanding of Evidence Based Medicine and the application with care and decision making
• Proven ability to develop relationships with network and community providers and VA providers
• Proven data analysis and interpretation skills
• Proven ability to focus on key metrics
• Demonstrated superb communications skills
• Demonstrated excellent time management skills
• Demonstrated creative problem-solving skills
• Demonstrated ability to focus on priorities
• Demonstrated ability to timely and accurately complete time entries within Costpoint and Global Self Service per company policy
• Demonstrated ability to comply with all UHG and Optum employee policies
• Ability to travel less than 10%

Preferred Qualifications:

• 5+ years of experience in clinical quality
• Experience with Veterans and/or Military medical management  

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $248,500 - $373,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and help make the health system work better for everyone. Together, we are shaping the future of healthcare by harnessing technology and innovation to make care simpler to navigate, more affordable and more connected for the people we serve. We are committed to creating an inclusive workplace where everyone feels welcomed, valued, heard and respected, empowering people to bring their authentic selves to work and strengthening our collective impact through diverse talents, backgrounds, experiences and perspectives.

UnitedHealth Group and its affiliated brands are an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group and its affiliated brands are a drug-free workplace. Candidates are required to pass a drug test before beginning employment.