Medical Director | Do your life’s best work

Primary Responsibilities:

• Assist in RAF/HEDIS/STARS education to improve metrics
• Strategic leadership over the Independent Practice Affiliate Program in Arizona
• Apply understanding of patient care quality metrics to enhance clinical outcomes (e.g., HEDIS; 5 STAR; disease-based metrics) in order 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
• Provide assistance in appeals review where appropriate
• 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
• Travel will include Phoenix, Tucson & Yavapai mainly with expectation of Tuesday, Wednesday & Thursday to be visiting member clinics

Required Qualifications:

• MD or DO with an active, unrestricted license in AZ or ability to obtain one
• 5+ years of clinical practice experience
• Experience and knowledge of Medicare Advantage programs (STARS, RAF, HEDIS, CHAPS/HOS etc)
• Experience with identifying 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
• Proven ability to strategically lead regionally to ensure accurate diagnostic codes in order to maximize risk adjustment (RAF)

Preferred Qualifications:

• 2+ years of Quality Management experience
• Experience within managed care
• Proven working with senior leadership team to strategize and assess market trends etc.
• Proven to collaborate with Market Operations and Provider Relations staff in the market(s)
• Proven to assists in the identification of potential physician practice acquisitions in assigned market
• Proven in partnering 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 in developing and cascading clinical outcome/improvement messaging to business units to foster tighter working culture
• Proven in helping set agendas/strategies and leading multifaceted teams of Physician Business Managers, Risk Adjustment RNs, and Quality RNs
• Proven 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 to assist in the identification and development of current/new best practices in support of continuous financial and quality improvement
• Proven to serve as an integral dyad partner interfacing with Corporate level support divisions, to include: Quality, Risk Adjustment, Cost and Care

About Optum

Optum is the health care technology and innovation company of the UnitedHealth Group enterprise along with UnitedHealthcare. We’re a global organization that’s evolving health care so everyone can have the opportunity to live their healthiest life. With our hands across all aspects of health, we'll provide you with a rewarding career that enables you to grow in the directions that best fit your passions. This is your opportunity to be part of a team that’s dedicated to Caring. Connecting. Growing together.