You're looking for something bigger for your career. How about inventing the future of health care? UnitedHealthcare is offering an innovative new standard for care management. We're pushing ourselves and each other to find smarter solutions. The result is a culture of performance that's driving the health care industry forward. As a Medical Director you will use your talents to take our already-exceptional service and innovation to the next level. You will lead a team of world-class professionals who are removing barriers to better health with every new idea. Ready for a new path? Join us and start doing your life's best work.(sm)
What makes your clinical career greater with UnitedHealth Group? You can improve the health of others and help heal the health care system. Be a leader that is shaping our incredible team culture and be a part of a clinical and business collaboration that is learning and evolving every day.
The Medical Director of Ambulatory Care interacts with physicians and IPA staff to ensure that patient needs are met in an efficient and medically appropriate manner. The Medical Director of Ambulatory Care is responsible for the Medical Management functions that include Utilization Management and Case Management. The Medical Director shall work collaboratively with the Clinical Services Department to achieve the strategic goals of the department and Monarch HealthCare. In addition to UM and CM responsibilities, this Medical Director will be responsible for oversight of Clinical Informatics. This includes managing various sources of clinical data to maximize its impact on patient care. Both the flow of data into the department as well as data flowing out to the physician network requires orchestration. This position reports to the CMO of Monarch HealthCare.
- Responsible for oversight of Monarch HealthCare’s Utilization Management and Case Management for multiple payers and lines of business
- Oversees the Clinical Informatics and initiatives
- Be the final decision maker for the IPA on any denial of payment for outpatient services
- Develop and implement action plans, including clinical guidelines, to ensure clinically appropriate and efficient utilization of services
- Provide and/or supervise the education, guidance, assistance, and feedback to primary care physicians and specialty panels to achieve appropriate cost-effective patient care
- Oversee Case Management program implementation and ongoing case management programs, interfacing with case managers and other staff for medical advice and intervention as needed
- Monitor utilization trends and communicate program outcomes to IPA leadership and physicians
- Promote the appropriate utilization of clinical programs to manage complex and / or catastrophic cases and promote positive health outcomes; programs may include case management, disease management, anticoagulation clinic, and palliative care
- Participate in the development and implementation of initiatives designed to improve utilization management in the specific clinical areas such as avoidable ER use, and ancillary services
- Participate and lead Interdisciplinary Care Team Meetings as needed
- Develops a broad understanding of the various data elements available to the organization, working closely with the IT and EHR departments
- Ensures that data is being used consistently throughout the clinical department to improve patient outcomes
- Analyze data in order to improve UM and CM operational efficiency
- Analyze patient population data in order to assist CM and other clinical programs in engaging patients who would benefit most
- Interact with health plan medical directors on specific cases as needed, establishing strong working relationships with them
- Other duties and responsibilities as assigned by the CMO, President and officers of Monarch HealthCare
- Possess a current and unrestricted MD or DO license in California
- 3 or more years of clinical practice in direct patient care
- 3 or more years of medical management or administrative experience in a managed care setting
- Possess sufficient clinical knowledge to interact with the physician members of the IPA in all major medical specialties
- A proven track record of quality leadership and exceptional teamwork in order to build and foster stellar working relationships in both Clinical and Operational departments
- Excellent written and oral communication skills
- Board certification in their chosen specialty
- Demonstrated ability to lead teams and propose innovative and practical solutions
- Primary Care experience in adult or family medicine
- Prior experience working with clinical information technology systems
- Public presentation skills
What's the first thing that happens when one of the most successful physician groups in Orange County comes together with a global leader in health care? Opportunity. With Monarch HealthCare joining Optum and the UnitedHealth Group family of companies, people like you will find increasing levels of challenge, impact and professional success. With a vibrant network of hospitals and urgent care centers, we're changing health care for the better by improving access to affordable, high quality care, and working together to improve the patient experience. That takes passion, commitment, intense focus and the ability to contribute effectively in a highly collaborative team environment. Are you with us? Learn more about this exciting opportunity to do your life's best work.(sm)
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.
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