Optum Senior Community Care Market Medical Director - IN, IL, OH - Optum

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The Optum Home & Community Market Medical Director is a member of the Market’s Senior Leadership Team (SLT) for Senior Community Care (SCC). They will work with the SLT to develop and drive the business strategy, growth, and clinical operations and help to ensure that the highest level of quality care is being delivered to the residents of our partner nursing homes. This individual will work collaboratively with the site’s advanced practice clinicians (APCs) and will serve as a clinical resource.  This position is recognized as the clinical ‘face of the business’ related to the clinical and business communities. The Medical Director will interface with contracted nursing homes and their attending physicians across the market as needed. Preferred residency locations are Indiana, Illinois, and Ohio but we can consider candidates living in other states

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

Primary Responsibilities:

• Actively engage NP/PA clinical staff with didactic, small group and 1:1 education on geriatric syndromes, chronic illness, SNF regulations, and end of life/palliative care
• Particular focus on newly enrolled, post-hospitalization, and clinically complex patients
• Lead market review and operational plans to address pharmacy, acute hospitalization, skilled SNF services, DME, and medical expense management
• Lead the medical discussion for the weekly calls on avoidable hospital transfers
• Assist in quality of care case reviews and corrective action plans (CAPs) upon request
• Maintain knowledge of, and support compliance with, the Special Needs Plan (SNP) Model of Care, State, and Federal Regulations
• Collaborate with clinical leadership team to develop practice standards for front-line clinicians
• Develop processes, alongside Subject Matter Experts, to reach market and national benchmarks for STAR and HEDIS measures
• Support APC efforts to accurately and completely document and code diagnoses
• Collaborate with Business Development team and market SLT to identify potential Skilled Nursing Facilities (SNFs) and Provider Groups with new membership opportunities
• Oversee the orientation of new facility Medical Directors (SNFMDs) and Primary Care Physicians (PCPs) to the clinical model upon request and in concert with market SLT
• Meet with currently collaborating SNFMDs and PCPs as needed
• Promote the clinical and financial value propositions to new business and current partner stakeholders to achieve growth goals as needed
• Engage and speak with state and local organizations, Long Term Care (LTC) industry associations, medical society memberships, etc., regarding the value and quality outcomes of the Optum models of care
• Occasional travel in local and remote markets upon request
  
  

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 a full, active and unrestricted license to practice medicine in the State(s) of the market
• ABMS or AOA Board Certified in: Internal Medicine, Family Medicine, Geriatrics and/or Hospice/Palliative Care 
• 5+ years of experience working with geriatric and/or long-term care population
• Experience working with and educating APCs: Nurse Practitioners (NPs) and/or Physician Assistants/Associates (PAs) 

Preferred Qualifications:

• Certification by the American Board of Post-Acute and Long Term Care  (ABPLM)
• Health care management / leadership experience
• CMS, Medicare Advantage, Special Needs Plans (SNP) Rules and Regulations
• HCC and Risk Adjusted reimbursement methodology
• Inpatient / SNF utilization metrics and bed day management
• Financial Reports: Revenue; Expenses; Contribution Margin; Budgeting & Forecasting; BCR; IOI
• New Jersey specific collaborative practice agreements and midlevel practitioner licensing
• Working knowledge of EMR structures

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

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, Washington, or Washington, D.C. Residents Only: The salary range for this role is $286,104 to $397,743 annually. Salary Range is defined as total cash compensation at target. The actual range and pay mix of base and bonus is variable based upon experience and metric achievement.  Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

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 make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer 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.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.