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Market Medical Director, Optum Home and Community - Telecommute in NJ

Company: Optum
Location: Basking Ridge
Posted on: September 22, 2022

Job Description:

Medical Director opening in Basking Ridge, New Jersey. This and other physician jobs brought to you by DocCafe

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)



Medical Director Careers at UnitedHealth Group (UHG) 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 a handful of patients each day, your work may affect millions for years to come.



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 when needed. 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.



You'll enjoy the flexibility to telecommute* in New Jersey as you take on some tough challenges.



Primary Responsibilities:


  • Achieve sustainable, profitable growth via new business development and growth
  • Promote the clinical and financial value propositions to new business and current partner stakeholders to achieve growth goals
  • 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
  • Develop and sustain solid relationships with other medical directors and health care system leaders in market territory
  • Actively engage NP / PA clinical staff with didactic, written and 1:1 education on geriatric syndromes, chronic illness, SNF regulations, and end of life / palliative care
  • Assist in quality-of-care concern case reviews and corrective action plans (CAPs)
  • Lead the medical discussion for the weekly calls on avoidable hospital transfers (TAP Calls)
  • Fulfill requirements for Special Needs Plan (SNP) Model of Care, State, and Federal Regulations
  • Lead market review and develop education and operational plans to address pharmacy, acute hospitalization, skilled SNF services, DME, and medical expense management
  • Commute to main office, for meetings, approximately every other month, and upon request




    Secondary Responsibilities:


    • Coordinate and facilitate the orientation of all new Primary Care Physicians (PCPs) to the model
    • Meet with currently collaborating PCPs as needed
    • Collaborate with Business Development team to identify potential Skilled Nursing Facilities (SNFs) and Provider Groups with new membership opportunities
    • Assist with the revision of clinical practice standards and procedures
    • Assume a leadership role for achievement of targets for market or contract specific STAR and gap closures; HEDIS measures; and Quality Improvement Programs
    • Provide leadership accountability for ensuring accuracy of all documentation and coding
    • Educate NP / PA staff in use of coding tools and documentation requirement
    • Assume less than 25%-day travel within the market territory as noted above




      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:


      • DO or MD with a full, active, and unrestricted license to practice medicine in New Jersey
      • AOA or ABMS 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 (PAs)
      • Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation




        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 experience
        • HCC and Risk Adjusted reimbursement methodology experience
        • Inpatient / SNF utilization metrics and bed day management experience
        • Financial Reports: Revenue; Expenses; Contribution Margin; Budgeting & Forecasting; BCR; IOI experience
        • New Jersey specific collaborative practice agreements and midlevel practitioner licensing
        • Working knowledge of EMR structures




          Metrics / Goals:


          • Admits per 1000 Member Months (APK; APT)
          • Readmissions
          • Appropriate SNF Days Utilization
          • Key Medical Expense Metrics / Medical Expense Management (MEM)
          • Overall Plan STAR Rating and individual STAR/HEDIS measures for each patient
          • Appropriate documentation and coding to attain the accurate Risk Adjustment Factor (RAF)




            To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment



            Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. 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. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)



            *All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.





            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.

            Keyphrases: health administration jobs, medical director jobs, hospital administration jobs, hospital administrative jobs, healthcare administration jobs, administration jobs, healthcare administrator jobs, medical administration jobs, chief medical officer jobs, medical director position jobs, associate medical director jobs, medical ceo jobs, healthcare ceo jobs, medical administrative jobs, executive director jobs

Keywords: Optum, Newark , Market Medical Director, Optum Home and Community - Telecommute in NJ, Executive , Basking Ridge, New Jersey

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