1+ months

Medical Director Complex Care Management NYC area

United Health Group
New York, NY 10007
  • Job Code

The Medical Director career with UnitedHealth Group is anything but ordinary. We push ourselves and each other to find smarter solutions. The result is a culture of performance that's driving the health care industry forward. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Join us. And start doing your life's best work. (sm)


Reporting to the Regional Medical Director, this Medical Director is a member of the Leadership Team for Optum Complex Care Management. They are responsible for working with the Senior Leadership team to develop and drive the business strategy, growth and clinical operations in the Downstate New York area; which may also include the NJ market. They will interface with contracted nursing homes and their attending physicians and collaborate with a Medical Director partner to help to ensure that the highest level of quality care is being delivered to the residents of our partner nursing homes. In addition, they will work collaboratively with the site's advanced practice clinicians and will serve as a clinical resource when needed. The Medical Director does not provide direct patient care but rather is recognized as the clinical €˜face of the business' related to the clinical and business communities.


Primary Responsibilities:

  • Achieve sustainable, profitable growth via new business development and growth
  • Promote the clinical and financial value propositions to new business and current partner stakeholders to achieve growth goals
  • Coordinate and facilitate the orientation of all new PCPs to the model
  • Routinely meet with currently collaborating PCP's
  • Collaborate with Business Development team to identify potential SNFs / Provider Groups with new membership opportunities
  • Engage and speak with state and local organizations, LTC industry associations, medical society memberships, etc. regarding value and quality outcomes of the models
  • Develop and sustain strong relationships with other medical directors and health care system leaders in market territory
  • Actively engage NP / PA clinical staff with didactic, written and 1:1 education on geriatric syndromes, chronic illness, SNF regulations, and end of life / palliative care
  • Assist in quality of care concern case reviews and corrective action plans
  • Develop and revise clinical practice standards and procedures
  • Fulfill requirements for SNP Model of Care; State; and Federal regulations
  • Leadership role for achievement of targets for market or contract specific STAR and HEDIS measures and Quality Improvement Programs
  • Lead market review and develop education and operational plans to address pharmacy , acute hospitalization, skilled SNF services, DME, and physician medical expense
  • Provide leadership accountability for ensuring accuracy of all documentation and coding
  • Educate NP / PA staff in use of coding tools and documentation requirements
  • Attend weekly meetings at NYC Penn Plaza location
  • 30-40% day travel within the NYC/Downstate NY market


Metrics / Goals:

  • Admits per 1000 (APK; APT)
  • Readmissions
  • SNF day's utilization
  • Key Medical Expense Metrics / Medical Expense Management
  • Overall Plan STAR Rating and individual STAR/HEDIS measures for each patient
  • Appropriate documentation and coding to attain an accurate Risk Adjustment Factor (RAF) for each patient

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.



Posted: 2020-08-11 Expires: 2020-10-10

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Medical Director Complex Care Management NYC area

United Health Group
New York, NY 10007

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