Network Medical Director

Optum NV is seeking a Network Medical Director to join our team in Las Vegas, NV. Optum is a clinician-led care organization that is changing the way clinicians work and live.

As a member of the Optum Care Delivery team, you'll be an integral part of our vision to make healthcare better for everyone.

At Optum, you'll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Here, you'll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together.

Optum is the largest network of health care providers in the United States, whose mission is to connect and support providers by working together to deliver the most effective and compassionate care to each and every patient they serve. Optum's focus is to do the right things for patients, physicians, and the community. Optum's Core Business is contracting directly with health insurers to deliver a highly personal care management and service model to their patients. A main focus of Optum is on seniors, and those with complex care needs, who most benefit from a high touch model of care.

The IPA Medical Director in NV will report to the Nevada Market President. The IPA Medical Director will assist 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 solid, trusted relationships with other providers to influence and advance 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 Market President, CMO and the greater team. They will support the market 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 may be meeting with providers 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.

Primary Responsibilities:

• Strategic leadership over the Independent Practice Affiliate Program in Nevada
• Apply understanding of patient care quality metrics to enhance clinical outcomes (e.g., HEDIS; 5 STAR; disease-based metrics) to drive/achieve quality outcomes
• Supporting all clinical quality initiatives and peer review processes
• Effectively engaging and bringing understanding to our external constituents such as physicians, medical and specialty societies, hospitals and hospital associations, and state regulators
• Identifying opportunities through participation in local medical expense committees or market reviews
• Assist in RAF/HEDIS/STARS education to improve metrics
• Understand, mentor and support value-based care for our contracted primary care and specialty providers
• Assist with the evolution and implantation of incentive models for the IPA physicians
• Leading and building the team responsible of oversight of the HEDIS data collection process, CAHPS (Consumer Assessment of Healthcare Providers and Systems) improvement, and drive Health Plan accreditation activities
• Member of the MSSP (Medicare Share Saving Plan) board and support independent physicians that are on the MSSP panel
• Help affiliated physicians and group preform on the Quadruple aim

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 in NV or ability to obtain one
• 5+ years clinical practice experience
• Experience and knowledge of Medicare Advantage programs (STARS, RAF, HEDIS, CHAPS/HOS etc.)
• Experience with Medicare risk adjustment and presenting findings to client/providers
• Experience with patient care quality metrics (e.g., HEDIS; 5 STAR; disease-based metrics) in driving/achieving quality outcomes
• Working knowledge of managed care, and value based medicine
• Understanding of patient satisfaction, surveys, and performance improvement
• Proven ability to strategically lead to ensure accurate diagnostic codes in order to accurately reflect risk adjustment (RAF)

Preferred Qualifications:

• 2+ years Quality Management experience
• Experience within managed care
• Working with senior leadership team to strategize and assess market trends etc.
• Proven ability to collaborate with Market Operations and Provider Relations staff in the market(s)
• Proven ability to assist in the identification of potential physician practice acquisitions in assigned market
• Proven ability to partner with the Clinical Affordability team to support new innovative approaches to making healthcare more efficient and meaningful to PCPs and patients alike; ultimately bending the cost curve in region
• Proven ability to develop and cascade clinical outcome/improvement messaging to business units to foster tighter working culture
• Proven ability to help set agendas/strategies and leading multifaceted teams
• Proven ability to assist driving aligned performance in largely an independently contracted provider network through the development of meaningful relationships, financial and quality incentives, best practices, forward thinking solutions to improve our value proposition to medical providers
• Proven ability to assist in the identification and development of current/new best practices in support of continuous financial and quality improvement
• Proven ability to serve as an integral dyad partner interfacing with Corporate level support divisions, to include: Quality, Risk Adjustment, Cost and Care

The salary range for this role is $238,000 to $357,500 annually based on full-time employment. 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.

OptumCare is 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.

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