IPA Medical Director - Denver, CO

Denver, CO

Key Info

full-time

Non clinical

The IPA Medical Director in CO will report to the Chief Medical Officer (CMO). The IPA Medical Director will assist the CMO 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 strong, trusted relationships with other providers to influence and change 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 CMO and leadership team. They will support the CMO with utilization management (UM), prior authorization determinations, oversight and direction of inpatient and skilled nursing facility utilization, 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 Colorado

• 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

• Effectively engaging and bringing understanding to our external constituents such as physicians, medical and specialty societies, hospitals and hospital associations, and state regulators

• Provide assistance in appeals review where appropriate

• Assist in RAF/HEDIS/STARS education to improve metrics

Required Qualifications:

• MD or DO with an active, unrestricted license in CO or ability to obtain one

• 5+ years clinical practice experience


Posted June 23, 2020

Covered

Not Covered