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Senior Inpatient Case Management Medical Director - Virtual more...
Location:New York, NY
Company:UHC Clinical Services
First posted:May 11, 2017

Senior Inpatient Case Management Medical Director United Clinical Services
Purpose of Job: UnitedHealthcare Clinical Services (UCS) conducts medical management activities for commercial and government business.. The majority of these activities are concentrated in inpatient review and appropriate inpatient utilization, although depending upon location and products covered, functions such as pre-certification and other traditional utilization management activities may be performed. The UCS medical director is part of a national organization and team, and will collaborate with UCS peers, market medical directors and others from across the country. In response to customer need and expectation, UnitedHealthcare is continuously modifying its programs and approaches. Although not a primary job function, medical directors with the interest in doing so often have the opportunity to be involved with change design and management. UnitedHealthcares care management approach is data driven, and grounded in the use and application of evidence based medicine (EBM) and guidelines. The successful UCS medical director appreciates and understands data, is a champion of and is very conversant with evidence-based medicine, and uses nationally recognized clinical guidelines to teach and direct clinical staff, as well as engage the practicing community in discussions designed to result in individual patients receiving the right care, in the right place, at the right time. Senior clinical executive represented on the Regional Executive Management Team and responsible for contributing to the policy and operational objectives of the region Senior clinical liaison to regional Network Management, Sales, Underwriting, Regulatory Affairs, Operations and Public Affairs for the region Senior clinical executive participates in the development and execution of national clinical strategies and programs, clinical operations, and clinically integrated networks Leadership for the network medical management, or field-based medical management programs and results, including inpatient and professional outcomes and trends Leadership for regionally developed health care affordability initiatives and execution of national affordability initiatives Senior clinical executive responsible for health care quality, quality improvement, HEDIS/CAHPS performance, accreditation and compliance programs, physician engagement and improvement, local physician professional society liaison, regulatory agencies, local quality improvement coalitions, etc. Provides regional executive management with information/tools for strategic decision making and planning. Provides consultative advice to regional network management regarding the medical delivery system, enhancement to services, provider patient care issues. Ensures integrity of functional areas for compliance with state and federal guidelines. Interfaces with medical societies and other regional collaborations. Provides clinical leadership to regional sales efforts.

Skills and experience required 10+ years post residency clinical practice experience Required Unrestricted medical licensed physician Required Board Certified in ABMS/ABOMS specialty Required Strong knowledge of managed care industry. Supervisory skills including clinical mentoring and coaching skills. Data analysis and interpretation skills. Ability to focus on key metrics. Ability to develop relationships with network and community physicians and other providers. Comfort with visibility and involvement in medical community. Excellent telephonic communication skills; excellent interpersonal communication skills. Excellent project management skills. Excellent presentation skills for both clinical and non clinical audiences. Familiarity with current medical issues and practices. Creative problem solving skills. Strong team player and team building skills. Comfortable with change, and able to lead others through it Is a champion of EBM, and in particular of MCG which currently are the companys primary review guidelines. Through use and/or analysis of available data (e.g., APR/DRG), identifies more global opportunities for intervention that may 1) better focus available review resources and activities, and/or 2) change practice or hospital habit. Develops clinical strategy, identifying areas of clinical focus, developing initiatives to improve appropriate inpatient utilization and other functions and representing same to senior management.

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.SM
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.

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