Medical Director Per Diem - Utah

UnitedHealth Group • Draper, UT

223d • $34 - $67 • Remote

About The Position

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. The Optum Medical Director is responsible for driving quality care to all Optum SLCo members in the right place at the right time. The Medical Director monitors the treatment of specific members in any level of care. She is responsible for conducting peer reviews when a care advocate advises a member no longer meets the level of criteria per LOCUS, CASII and ESCII. She engages in case staffing twice weekly to ensure inpatient behavioral health care is progressing and the inpatient team is using medical and psychiatric best practices when rendering care to Optum SLCo members.

Requirements

• Doctor of Medicine or Osteopathy.
• Current license to practice as a physician without restrictions in the state of Utah.
• Board certified in Psychiatry.
• 2+ years of management experience overseeing multidisciplinary teams.
• Demonstrated understanding of the clinical application of the principles of engagement, empowerment, rehabilitation and recovery.
• Knowledge of post-acute care planning such as home care, discharge planning, case management, and disease management.
• Computer and typing proficiency, data analysis and solid organizational skills.

Nice To Haves

• 5+ years of experience as a practicing psychiatrist post residency.
• 2+ years of managed care experience.
• Experience in public sector delivery systems and experience in state specific public sector services.
• Experience working with community-based programs and resources designed to aid the State Medicaid population.

Responsibilities

• Directly outreach inpatient attending physicians to consult on specific individuals in real time, impacting the quality of care during treatment and for discharge planning.
• Review of records and each member's history of care to assess if medical and pharmaceutical treatments are appropriately prescribed and delivered to maximize the opportunity for improved health and better outcomes from treatment.
• Analyze hospital readmissions and identifies patterns of facility/provider practice that may be contributing to these readmissions.
• Collaborate with members of care advocacy and care coordination teams to problem solve challenges related to lack of access to the Utah State Hospital.
• Identify alternative treatment and service options within the inpatient setting or in a lower level of care with more wrap-around supports.
• Investigate sentinel events involving SLCo Medicaid members, which requires extensive record and policy review, consultation with Optum's Clinical Team, identifying quality of care concerns which may have contributed to the event and presenting incident and recommendations to the Optum National Sentinel Event Committee.
• Review outcomes of related QOC audits and provider corrective action plans to improve member safety.
• Review possible QOC concerns identified by a member, member representative, Optum provider, Optum staff, courts and SLCo DBHS.
• Investigate the concerns, rate the level of impact to the member and present findings and recommendations to the Optum National Peer review Committee.
• Direct follow-up with the provider and review of provider responses focusing on improving safety of members, their families and program staff.
• Provide recommendations for network trainings and messaging to minimize similar incidents with other providers, when appropriate.
• Monitor progress by reviewing data gathered related to these incidents to determine if patterns emerge.

Benefits

• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase.
• 401k contribution.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Insurance Carriers and Related Activities
• Education Level: Ph.D. or professional degree