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  • Rochester, NY

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Medical Director, CCM - Upstate/Rochester NY

UnitedHealth Group • Rochester, NY

Posted 20 days ago

Job Snapshot

Healthcare - Health Services
Health Care

Job Description

Medical Director careers at UnitedHealth Group are 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)
This Medical Director is a member of the Senior Leadership Team (SLT) of the Upstate New York, Optum Complex Care Management team. They will work with SLT to develop and drive the business strategy, growth and clinical operations and help to ensure that the highest level of quality care is being delivered to the residents of our partner nursing homes. This individual will work collaboratively with the sites advanced practice clinicians and will serve as a clinical resource when needed.  As the site Medical Director this position is recognized as the clinical ‘face of the business’ related to the clinical and business communities.  The Medical Director will interface with contracted nursing homes across upstate NY (Jamestown, Buffalo, Rochester, Syracuse Utica and Albany).
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; 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
  • 30-40% day travel within Upstate NY

Required Qualifications:
  • MD or DO in State of NY
  • ABMS Board Certified in: Internal Medicine, Family Practice, Geriatrics or Hospice/ Palliative Care 
  • 5+ years of experience working geriatric and/or long-term care population
  • Demonstrated experience working with and educating NP’s and PA’s 
Preferred Qualifications:
  • Health care management/leadership experience
  • CMS, Medicare Advantage, SNP Rules and Regulations
  • HCC and Risk Adjusted reimbursement methodology
  • Inpatient / SNF utilization metrics and bed day management
  • Financial Reports: Revenue; Expenses; Contribution Margin; Budgeting & Forecasting; BCR; IOI
  • State specific collaborative practice agreements and midlevel practitioner licensing
  • Working knowledge of EMR structures

UnitedHealth Group is working to create the health care system of tomorrow.

Already Fortune 6, we are totally focused on innovation and change. We work a little harder. We aim a little higher. We expect more from ourselves and each other. And at the end of the day, we're doing a lot of good.

Through our family of businesses and a lot of inspired individuals, we're building a high-performance health care system that works better for more people in more ways than ever. Now we're looking to reinforce our team with people who are decisive, brilliant - and built for speed.

Come to UnitedHealth Group, and share your ideas and your passion for doing more. We have roles that will fit your skills and knowledge. We have diverse opportunities that will fit your dreams.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

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

Job ID: 2551_716967
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