Community & State Health Arizona Health Plan Medical Director for Special Health Care Needs/DDD
Company: UnitedHealth Group
Location: Tempe
Posted on: September 20, 2023
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Job Description:
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 equitable.
Ready to make a difference? Join us to start Caring. Connecting.
Growing together. -
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The C&S Plan Medical Director for Special Health Care Needs
(SHCN) has accountability for ensuring that local health plan,
United Clinical Services and UHC initiatives focusing on delivering
clinical excellence, quality ratings improvement with the goal to
be best in class, appropriate inpatient and outpatient
covered-service utilization and support health care affordability.
Medical Directors are expected to help drive integrated health
system transformation including working with Accountable Care
Organizations, Alternative Payment Models, assisting to address
provider network engagement and issues, support mandated legal and
contractual provisions, compliance, growth strategies and
develop/lead focused improvement projects that are implemented and
successfully managed to achieve goals. This position reports to the
local C&S plan CMO and has dotted line relationships to the
Plan CEO, C&S market-assigned Regional Chief Medical Officer
and C&S Chief Medical Officer. The C&S Plan Medical
Director primary responsibilities are directed towards C&S plan
activities as defined by the C&S plan CEO and collaborates with
Enterprise Clinical Services (ECS) staff, Optum Behavioral Health
staff, and other market and regional matrix partners to implement
programs to support and meet market C&S, UHC and line of
business goals. This position has direct supervision of one or more
employees, including the Adult or Child Healthcare Administrator
and close collaboration with peer Medical Directors.
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If you are located in Phoenix, AZ, you will have the flexibility to
work from home and in the office 2-3 days a week in this hybrid
role* as you take on some tough challenges.
Primary Responsibilities: -
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Quality + Affordability - The Plan Medical Director has primary
responsibility and accountability for medical performance and
targets for the local C&S plan(s) being overseen. This will
require a close working relationship with the plan CMO, local plan
staff, UCS and OBH clinical operations teams as well as with the
C&S and UHC national affordability team. Activities may include
conducting Joint Operations Committee meetings with prioritized
providers and Accountable Care Organizations, in coordination with
Network and ECS, contributing to and implementing programmatic and
strategic decisions, data sharing with physicians and physician
groups on quality and efficiency improvement opportunities, and
implementing local Health Care Affordability Initiatives. The
Medical director will be engaged as a clinical lead for healthcare
affordability initiatives at the local market and establishing a
process for sharing data and completing peer to peer communications
as required. Additionally, the Plan Medical Director has primary
responsibility to help support and oversee new and existing
clinical model operations, including Accountable Care
relationships, Whole Person Care and affiliated care management
programs, regulatory programs such as those defined by the Center
for Medicare and Medicaid Services (CMS) like the Model of Care.
They will support the CMO for medical dental, pharmaceutical, and
or social initiatives and quality programs as required to achieve
the appropriate utilization, affordability, HEDIS and Star goals of
the C&S Health Plan. Medical Director is accountable for
building and leaning into relationships with internal and external
partners to meet or exceed market, regional and national
requirements. The Plan Medical Director has contributing oversight
responsibility of the C&S market peer review process as defined
by State regulator as well as participating in or leading the
applicable committees such as Provider Advisory Committee (PAC) and
Healthcare Quality Utilization Management (HQUM). They will work
teams to direct all member care to in-network providers unless care
cannot be provided in network and in state. In which case, they
will work to complete single case agreement for the highest quality
and most cost-effective care with an AHCCCS registered provider or
facility.
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Clinical Excellence, Quality Standards and Service Performance -
The C&S plan Medical Director helps oversee, and contribute to,
the HEDIS and STARs process and improvement and performance
strategy, CAHPS and NPS improvement strategies and support
necessary Health Plan accreditation activities. The plan Medical
Director is required to help achieve or exceed all applicable
HEDIS, Stars and local state performance targets and goals
otherwise specified for the local C&S plan. The Medical
Director should act as an improvement catalyst for all service and
quality-related efforts, influence, participate and communicate to
ACOs and other network providers or vendors on new focus and
measure/process changes. The Medical Director supports all Clinical
Quality initiatives and peer review processes including Quality of
Care and Quality of Service (grievance) issues and is responsible
for representing the local C&S plan at State-level Fair
Hearings and performing plan-level member/provider grievance and
appeals reviews, as necessary. They will also actively participate
in or lead Physician Advisory Committees (PAC); Healthcare Quality
Utilization Management (HQUM), Quality Management Committee (QMC)
and other associated quality and/or member/provider service-focused
committees.
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Innovation and Focused Improvement - As Medical Director, a culture
of innovation and continuous improvement identification is to be
incorporated at all levels of work. They are expected to
collaborate with peers, Health Services, Quality Management,
Behavioral and key health plan staff such as the Adult and Child
Healthcare Administrators and UHC network management colleagues in
efforts to transform the health system and exceed all regulatory
expectations. Local responsibilities include driving/supporting
Accountable Care Organization growth and performance improvement,
growth, APM deployment, target setting monitoring, as well as
ongoing leadership during monthly JOCs. Knowledge of payment reform
and value-based contracting variants for C&S will be required.
Medical Director is accountable for oversight or support of the
various clinical models within the market, such as Whole Person
Care, Care Advocacy, Continuum of Care, and complex care
multidisciplinary rounds. Secondary responsibilities will include,
but are not limited to, other clinical practice transformation
efforts, patient-centered medical and behavioral health homes,
innovative vendor and provider-led care coordination programs,
health disparity assessments and action planning, high-performance
network development and consumer engagement.
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Growth, Equity, Inclusion and Diversity - The Medical Director will
help deliver our clinical value proposition focused on quality,
affordability, and service, in support of growth activities of the
C&S Health Plan, consistent with our prevailing values and
culture. The plan Medical Director reviews and edits policies,
SOPs, communications materials as required and represents the voice
of the market-based customer in program design. Medical Director
contributes to any RFP/re-procurement activity in the state, as
requested, delivering subject matter expertise and clinical
perspectives. The Plan Medical Director actively promotes positive
relations with State/local regulatory authorities and Medical
Societies, where possible, will participate with partner
organizations, health equity and disparity efforts such as the
DE&I counsel, promote cultural competencies and other factors
which holistically help the health plan better meet community and
member needs.
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Relationship Equity and State Compliance-The Plan Medical Director
maintains a solid working knowledge of all government mandates and
provisions for the local C&S market, as well as working across
the enterprise to implement and maintain compliant clinical
programs and procedures. They participate as a SME in reviewing
work plans and in operational reviews and audits. They also are
committed to being effectively and positively engaged with our
external constituents such as consumers/members, physicians,
medical and specialty societies, hospitals and hospital
associations, federal/state regulators, and market-based
collaborative. The Medical Director will work collaboratively in
these activities with ongoing ECS and C&S initiatives under the
direction of the Plan CMO, C&S Medical Director/CMO and/or the
C&S Regional CMO. The Plan Medical Director will be called upon
to support outward facing relationships to State regulators based
upon Contract, and direction of Plan CMO, Plan President and
C&S CMO and should provide clinical thought leadership with
external entities and the state. All public speaking and media
documents must be approved via appropriate UHC protocols. All
outside committee, teaching, board, or non-profit board
participation must be approved via appropriate UHC protocols.
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You'll be rewarded and recognized for your performance in an
environment that will challenge you and give you clear direction on
what it takes to succeed in your role as well as provide
development for other roles you may be interested in. -
Skills, Experiences, Qualifications:
Ability to successfully function in a matrix organization
exhibiting the culture of United Health Group
Leadership Expectations:
Deliver value to members by optimizing the member experience and
maximizing member growth and retention
Lead and influence Health Plan employees by fostering teamwork and
collaboration, driving employee engagement, and leveraging
diversity and inclusion
Develop and mentor others while also building awareness to your own
strengths and development needs
Influence and negotiate effectively to arrive at win-win
solutions
Communicate and present effectively, listen actively and
attentively to others, and convey genuine interest
Lead change and innovation by demonstrating emotional resilience,
managing change by proactively communicating the case for change
and promoting a culture that thrives on change
Play an active role in implementing innovation solutions by
challenging the status quo and encouraging others to do so
Drive sound and disciplined decisions that drive action while
effectively using financial knowledge and data to manage the
business
Drive high-quality execution and operational excellence by
communicating clear directions and expectations
Manage execution by delegating work to maximize productivity,
exceed goals and improve performance
Arizona C&S Qualifications:
Working knowledge of the Arizona Health Care Cost Containment
System (AHCCCS), Department of Economic Security (DES), Arizona
department of Health Services (ADHS) and other related state
agencies
Experience and/or direct working knowledge of the AHCCCS health
plan types (Complete Care; DD; LTC)
Understanding of dual Special Needs health plans (DSNP) and
Medicare/Medicaid integration and coordination of benefits with
DSNP or other third-party payers
Clinical, professional knowledge and interest in special heath care
needs (SHCN) populations and fully integrated healthcare models
Ability to develop solid, trusted relationship with Division of
Developmental Disability and immediate availability for regulator
concerns
A willingness to travel locally, in Arizona, to communities where
clinical partnerships require face to face interactions
General and SHCN Qualifications:
Active/unrestricted Arizona Licensed physician
Board Certified in an ABMS or AOBMS specialty
5+ years of clinical practice experience
2+ years of Quality management experience
Solid knowledge of managed care industry and the Medicaid line of
business including Division of Developmental Disability (DDD) Long
Term Care (DD LTC) and members requiring Children Rehabilitative
Services (CRS)
Familiarity with current integrated medical and behavioral health
issues and practices
Solid leadership skills, as demonstrated by continuously improved
results, team building, and effectiveness in a highly matrixed and
integrated organization
Excellent interpersonal communication skills
Superior presentation skills for both clinical and non-clinical
audiences
Proven ability to develop relationships with network and community
physicians and other providers
Excellent project management skills
Solid data analysis and interpretation skills
Ability to focus on key metrics pertinent to enterprise and Arizona
Community Plan goals
Solid team player and team building skills
Strategic thinking with proven ability to communicate a vision and
drive results
Solid negotiation and conflict management skills
Creative problem-solving skills
Innovative thinking and ability to develop innovations with an eye
for impact of emerging technology on enterprise and on AHCCCS
Arizona Complete Care (ACC) and Division of Developmental
Disability (DDD) Developmental Disability Long Term Care (DD LTC)
members
Proficiency with Microsoft Office applications (Word, Excel,
PowerPoint)
Provide education to all integrated and supportive teams (Optum
Behavioral Health, Clinical Services) regarding contractual and
regulatory requirements for members with SHCN, including but not
limited to DD LTC and CRS
Maintain relationship with all leadership Multi Specialty
Interdisciplinary Clinics in the state of Arizona
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At UnitedHealth Group, our mission is to help people live healthier
lives and make the health system work better for everyone. We
believe everyone-of every race, gender, sexuality, age, location
and income-deserves the opportunity to live their healthiest life.
Today, however, there are still far too many barriers to good
health which are disproportionately experienced by people of color,
historically marginalized groups and those with lower incomes. We
are committed to mitigating our impact on the environment and
enabling and delivering equitable care that addresses health
disparities and improves health outcomes - an enterprise priority
reflected in our mission. - - - -
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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. - - - - - -
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UnitedHealth Group is a drug - free workplace. Candidates are
required to pass a drug test before beginning employment. - -
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Keywords: UnitedHealth Group, Tempe , Community & State Health Arizona Health Plan Medical Director for Special Health Care Needs/DDD , Healthcare , Tempe, Arizona
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