Network Medical Director | Do your life’s best work

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

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

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.