Director, Medical Director

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. For those who want to invent the future of health care, here’s your opportunity. We’re going beyond basic care to health programs integrated across the entire continuum of care. We’ll put you in the driver’s seat on vital projects that have strategic importance to our mission of helping people lead healthier lives. We need your organizational talents and business discipline to help fuel ours.  UnitedHealthcare’s Medicaid health plan in Texas is experiencing substantial geographic expansion and membership growth in light of our recent successful re-procurement award by the state Medicaid regulator. The Medical Director is responsible for clinical leadership and execution of the Texas Medicaid managed care programs, in collaboration with the health plan Chief Medical Officer and health plan medical director colleagues.  The Medical Director has accountability for ensuring that health plan initiatives associated with the Medicaid membership, and focusing on clinical excellence, quality ratings improvement, affordability, mandated provisions and compliance, growth and focused improvement, are implemented and successfully managed to achieve goals. We’re focused on improving the health of our members, enhancing our operational effectiveness and reinforcing brand and reputation for high-quality health plans. Join us and help guide our efforts to improve the patient experience. Reports to health plan Chief Medical Officer (CMO), with accountability to health plan’s Executive Directors of the STAR+PLUS, MMP, STAR Kids, and STAR and CHIP teams Leadership role in local clinical operations and clinical quality initiatives  Collaborates with CMO, Senior Health Services Director and Director of Clinical Operations, Senior Director of Complex Care Management, Senior Director of Quality Management and other health plan leaders to implement programs to support the membership and to meet health plan goals Works toward fully integrated clinical model, providing support and guidance to service coordinators and care managers, and other clinical staff including transitional care management, disease management, and behavioral health teams Liaison to network management for physician and provider network development related to acute care and Home- and Community-Based services Manages external physician relationships, acts as community ambassador, and works with Executive Directors in developing new business opportunities If you are located in Texas, you will have the flexibility to work remotely* as you take on some tough challenges. Clinical Excellence – This medical director acts as an improvement catalyst for clinical quality efforts including state Pay-for-Quality program-related initiatives.  Facilitates alternative payment models with providers by clinical data sharing and strategy recommendations with physicians and other providers.  Promotes implementation of accountable care organizations.  Responsible for complex case reviews with care coordinators and clinical staff, including leadership of medical-behavioral integrated care conferences and leadership of various interdisciplinary team meetings.  Provides training to health plan clinical staff.  Supports peer review processes including Quality of Care issues.  Serves as liaison for Network development.  Holds internal and external stakeholders accountable for their roles in the Care Continuum by supporting health plan quality of care and medical expense management Affordability – This medical director ensures appropriate quality practices and utilization management from a macro view, for example, conducting hospital and physician practice Joint Operations Committee meetings jointly with Network Management, data sharing with physicians and physician groups on quality and efficiency improvement opportunities, and implementing local Health Care Affordability Initiatives Relationship Equity – This medical director maintains a solid working knowledge of relevant government mandates and provisions, working across the enterprise to implement and maintain compliant clinical programs and procedures.  Provides support for all external audits by state and other regulatory agencies.  S/he also is committed to being effectively engaged with our external constituents such as consumers/members, physicians, medical and specialty societies, hospitals and hospital associations, federal/state regulators, and market-based collaboratives. This commitment to regular, proactive dialogue will lead to collaboration around programs focused on improving health care to our members provide ongoing coaching and feedback to ensure peak performance Focus staff on the company’s mission; inspire superior performance; set clear performance goals; Drive exceptional performance; actively manage financial performance; balance speed with analysis; take well-reasoned risk; Ability to develop relationships with network and community physicians and other providers.  Visibility and involvement in medical community  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.  Active/unrestricted Texas Medical License ~ 2+ years of Population Health and/or Quality Management experience *All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy   At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.     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.