National Medical Director of Radiology and Imaging Programs - UHC

UnitedHealth Group•Minnetonka, MN

2d•$200,400 - $343,500•Remote

About The Position

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together. The National Medical Director of Radiology and Imaging Programs is responsible for leading the strategy, design, development, and oversight of payer-led radiology and imaging programs across UnitedHealthcare. This role will guide the modernization of radiology health plan medical management programs, including utilization management, prior authorization, post-service clinical review, clinical decision support, and evidence-based care pathways, with the goal of improving affordability, quality, provider experience, and member outcomes. This position will be reasonable for integrating UHC’s largest PA programs for Radiology and Cardiology which currently provides $425M or 19%25 of the direct medical expense savings. The position will also support UM modernization including increasing automation and reducing denials, and developing bundled authorizations, further contributing to reducing operating expenses and simplifying the prior authorization process.

Requirements

Doctorate of Medicine (MD or DO) degree with active/unrestricted medical license in one of more states
Board certified in Radiology or related specialty required
10+ years of clinical practice experience required

Nice To Haves

Possess solid clinical and operational knowledge having worked in the designated medical specialty of Radiology and Imaging

Responsibilities

Oversee the strategy for health plan Radiology and Imaging specialty programs using knowledge and understanding of the healthcare industry, emerging technology and trends, and current medical specialty guidelines and peer-reviewed literature, incorporating feedback from key stakeholders
Lead the design of clinical program development for modernizing utilization management and retrospective clinical review programs across the continuum of Radiology and Imaging procedures to improve health outcomes with a focus on member and provider experience
Provide leadership and clinical insights for Radiology and Imaging category activities across the enterprise such as value-based care programs, quality improvement initiatives, and care management
Identify pain points in current prior authorization processes and propose innovative solutions
Support effective implementation in partnership with teams in clinical operations and technology
Participate in the development of pilot programs and evaluate performance metrics for automation initiatives
Build and develop relationships across teams to ensure effective feedback loops and that deliverables are met
Set and review program metrics for continuous enhancements, updates, and improvement
Assess and interpret complex financial and clinical data to evaluate feasibility of proposed initiatives
Direct the healthcare analytics team as they work through hypothesis and problems and synthesize the results and to assure model assumptions are accurate
Evaluate clinical, quality and claims data to identify opportunities for improvement of clinical programs
Provide clinical insights and input to guide technology partners in development of large language learning models and technical capabilities for care pathways and bundled authorizations
Articulate and represent UHC clinical strategy to executive leaders across the enterprise and to external stakeholders and be able to speak clearly on complex problems
Advocate with leadership across the organization to create better alignment with business segments, network, and functional areas, thereby ensuring internal and external coordination and a unified approach to the market and associated constituents
Coordinate efforts of clinical, network, operations and HCE teams to support expansion of value-based programs delivered through our providers
Create and maintain solid relationships with key clinical leaders across the organization
Collaborate with the CMO, clinical, network and business leaders on top priorities and goals
Participate in key clinical committees
Solicit or respond to input on clinical initiatives
Influence development of clinical communications that will be delivered to external audiences. (e.g., new clinical policies, programs, processes)
Participate in the response development and delivery to high level questions, concerns and complaints from regulators, accreditors, legal/risk management, employers, healthcare providers, and other stakeholders
Discuss clinical program outcomes, data and performance with providers, employers, accreditors and regulators