National Accounts Medical Director - Remote

UnitedHealth Group•Birmingham, AL

17h•$248,500 - $373,000•Remote

About The Position

Optum, part of UnitedHealth Group, is seeking a National Accounts Medical Director to provide clinical leadership and help improve health system performance and care management. The position takes a member-centric approach through engagement with external stakeholders, program and product design improvement, site-related audits, and improvement initiatives. It offers remote work from anywhere within the United States, subject to UnitedHealth Group’s Telecommuter Policy. The Medical Director promotes the organization’s mission, vision, business strategy, and value proposition; collaborates with site and business leaders to meet goals; and develops nurses’ clinical judgment and performance through leadership, training, coaching, case discussions, and quality initiatives. The role reviews business and clinical metrics, advises business leaders on clinical matters and strategy, participates in customer-facing presentations and audits, supports sales and account management, and collaborates with customers on shared goals. It also provides clinical expertise for prospects and customers and supports community relations. As a case reviewer, the Medical Director conducts peer-to-peer discussions when indicated, reviews cases with nursing staff, coordinates complex care issues with enrollees’ physicians, and develops care plans intended to prevent readmissions. The role supports nurse development, quality reviews, regulatory and accreditation efforts, and clinical improvement studies; monitors medical director performance measures; and identifies provider issues involving compliance, utilization, quality, or evidence-based guidelines. As a physician liaison, the Medical Director works with regional and market teams, customers, other medical directors, sales and account management, clinical solutioning, health plans, network management, and OptumHealth partners to implement strategies and programs, acquire and retain customers, and improve care quality and outcomes. The role also participates in regional medical expense meetings and affordability initiatives, with attention to admissions, readmissions, bed-day management, high-cost claimants, and frequent utilization.

Requirements

MD or DO degree with an active, unrestricted medical license.
Active board certification from the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA).
At least 3 years of clinical practice experience.
At least 2 years of managed care experience, including utilization management, case management, affordability or cost-savings initiatives, quality management, and/or administrative leadership experience.
Proficiency with Microsoft Office applications.

Nice To Haves

Excellent written and oral communication skills with customer-facing experience.
Strong project management skills.
Solid data analysis and interpretation skills, with the ability to focus on key metrics.
Residence in Atlanta, Georgia, or Buffalo, New York.

Responsibilities

Promote and communicate the mission, vision, business strategy, and value proposition to staff through meetings, educational programs, documents, program and tool development, and case discussions.
Collaborate with Site Directors and Operations Product and Channel Leads to meet site, channel, and product goals.
Develop and evaluate nurses’ critical-thinking skills to improve quality and efficiency outcomes.
Provide nurses with leadership, training, and coaching on clinical opportunity identification, interventions, care-plan development, use of quality-rated providers, internal referrals, risk management, and quality-of-care issues.
Foster a professional and respectful work environment that supports staff morale, satisfaction, retention, commitment, and engagement.
Review business, trend, utilization, customer, nurse, and site performance metrics; present analysis and recommend action.
Consult with business leaders on clinical issues related to the business model, value levers, and strategy, product, or program development.
Participate in customer and consultant presentations, audits, sales and retention efforts, and responses to questions about clinical performance.
Be available on call for utilization and medical expense reduction questions and issues for customers and consultants.
Lead, participate in, or consult on project teams and collaborate with internal business partners on value levers and strategic initiatives.
Work collaboratively with customers on mutually defined goals.
Provide clinical expertise to prospects and customers and assist sales and account management teams in client meetings.
Support community activities that enhance Community Relations and Reputation.
Conduct peer-to-peer discussions when indicated to promote individuals’ health and well-being.
Use individual discussions and Medical Director Value Case Reviews to stimulate nurses’ critical thinking, identify clinical gaps, and coach staff on provider communication and care-plan development.
Coordinate and manage complex care issues with enrollees’ physicians and propose care plans to prevent readmission.
Promote 6C call conduct, Inductive Call Anatomy, warm and engaging consumer interactions, call efficiency, sound case-management principles, and measurable outcomes.
Work with Clinical Managers to improve nurses’ knowledge and case management through meetings, teaching sessions, audits, tools, and case discussions.
Adhere to medical director performance metrics and evaluations.
Use admission, readmission, and medical expense data to guide changes in case-level focus.
Alert UHC Medical Directors to provider compliance issues, overutilization, quality-of-care issues, and failure to follow evidence-based medicine guidelines.
Support quality reviews, inter-rater reliability sessions, regulatory requirements, accreditation and certification efforts, audits, and clinical quality improvement studies.
Collaborate with regions, markets, customers, UHG Medical Directors, sales, account management, clinical solutioning, health plans, network management, and OptumHealth partners to implement strategies and programs, acquire and retain customers, improve consumer care outcomes, and strengthen organizational relationships.
Attend regional monthly medical expense meetings and support regional affordability initiatives focused on admissions, readmissions, and bed-day management.
Understand and act on condition-specific cost drivers, including high-cost claimants and consumers with frequent utilization patterns.