Optum Serve Medical Director - VA Community Care Network - Remote in US

UnitedHealth Group•Tampa, FL

2d•$248,500 - $373,000•Remote

About The Position

The Optum Community Care Services (CCS) Medical Director oversees clinical quality provided by community care providers to Veterans served through the Veterans Administration Community Care Network (VA CCN). The role collaborates with Patient Safety Specialists to review medical records and determine applicable standards of care, chairs the Med/Surg Peer Review Committee, and helps ensure that committee activities meet applicable regulatory and legal requirements. The Medical Director also facilitates or attends other committees, including the Clinical Quality Improvement Program Committee. The role is accountable for implementing and managing clinical excellence initiatives and CCS clinical quality program requirements to meet performance expectations and contractual requirements. Responsibilities include clinical quality reviews of medical and surgical care and program integrity reviews involving regulatory compliance and health care delivery. The Medical Director works closely with internal and external partners, communicates professionally with them and clients, and may support utilization management activities such as concurrent review and prior authorization review under future contracts. Reporting to the Chief Medical Officer, Community Care Services, the Medical Director provides leadership to clinical staff through case consultation and reviews, recommends clinical quality process improvements, and manages applicable resource allocation. The role may consult with Optum Serve Technology and Consulting Solutions on federal health market consulting requests and contracts related to VA CCN, and supports the Chief Medical Officer on committees as needed. This is a remote position that may be performed from anywhere in the United States, with travel of less than 10%.

Requirements

MD or DO with an active, unrestricted license.
At least 5 years of clinical practice experience.
Familiarity with current medical issues and practices.
Proficient understanding of evidence-based medicine and its application to care and decision-making.
Ability to develop relationships with network, community, and VA providers.
Data analysis and interpretation skills.
Ability to focus on key metrics and priorities.
Strong communication skills.
Excellent time-management skills.
Creative problem-solving skills.
Ability to complete time entries accurately and on time in Costpoint and Global Self Service in accordance with company policy.
Ability to comply with UHG and Optum employee policies.
Ability to travel less than 10%.

Nice To Haves

Current board certification in Internal Medicine, Family Medicine, Surgery, Physiatry, or Emergency Medicine.
At least 5 years of experience in clinical quality.
Experience with Veterans and/or military medical management.

Responsibilities

Provide clinical leadership within Optum Serve and collaborate with the CEO, Community Care Services, which has responsibility for VA CCN.
Develop, coordinate, participate in, oversee, and monitor clinical quality program design, development, and implementation.
Collaborate with the Chief Medical Director, CCS, and CCS leadership on clinical quality management, cost initiatives such as Value Based Care, and medical management program development.
Work with clinical quality partners, including patient safety managers and specialists, the dental director, and the behavioral health director, to ensure adherence to clinical quality performance standards.
Support whole-person care, utilization management, and program integrity for future contracts as applicable.
Recommend clinical program enhancements and quality improvements that meet VACCN requirements and reflect emerging clinical solutions and evidence-based practices.
Provide clinical education to staff to support VACCN clinical quality program success.
Oversee VACCN clinical processes and care plans to ensure accepted guidelines and protocols are followed and appropriate clinical services are provided.
Ensure compliance with policies, procedures, bylaws, regulatory requirements, and best-practice guidelines.
Participate in implementation and process improvements for the VACCN clinical quality program.
Oversee evaluation and management of medical practices within Med/Surg Peer Review Committee requirements.
Recruit and maintain participation of external actively practicing providers and manage Independent Review Organizations (IROs) for specialty review when required.
Ensure consistent, continual monitoring of the quality of care delivered.
Recommend measures based on VACCN and other quality metrics, including Hospital Compare, HAC, and AHRQ measures established by the VA and Optum Serve.
Review completed charts regularly and promptly in preparation for Peer Review Committee activities.
Provide and receive ongoing feedback about clinical quality of care.
Assist with requests for information, requests for proposals, contracts, and growth opportunities through Optum Serve Consulting, where applicable.
Provide case consultation and case reviews, regularly update the Chief Medical Officer, CCS, and recommend clinical quality program process improvements.
Manage resource allocation as applicable to medical management practices within the role's scope.
Support the Chief Medical Officer, CCS, on committees and consult on federal health market requests and contracts related to VA CCN as needed.
Perform other duties as assigned to support Clinical Quality, CCS, and the enterprise.