Medical Director-LTSS-Choices - Brentwood, TN

You're looking for something bigger for your career. How about inventing the future of health care? UnitedHealthcare is offering an innovative new standard for care management. We're pushing ourselves and each other to find smarter solutions. The result is a culture of performance that's driving the health care industry forward. As a Medical Director you will use your talents to take our already-exceptional service and innovation to the next level. You will lead a team of world-class professionals who are removing barriers to better health with every new idea. Ready for a new path? Join us and start doing your life's best work.(sm)

What makes your clinical career greater with UnitedHealth Group? You can improve the health of others and help heal the health care system. Be a leader that is shaping our incredible team culture and be a part of a clinical and business collaboration that is learning and evolving every day.

The Long Term Care Market Medical Director has accountability for ensuring that Clinical Operations initiatives focus on affordability, clinical excellence, growth and focused improvement are implemented and successfully managed to achieve targets. 

Primary Responsibilities: 

• Responsible for leadership and execution of the Tennessee Medicaid (TennCare) Long Term Care program (Choices ). This encompasses both key affordability and clinical quality activities associated with the Choices membership


• Collaborates with the market lead Medical Director/Chief Medical Officer and LTC Choices Executive Director, clinical operations staff, and other market staff to implement programs to support and meet market and national clinical operations goals


• Provides support and guidance to the Choices care coordinators and clinical staff


• Works toward fully integrated clinical model working with Behavioral Health and non-Choices clinical management


• Liaison to network management for network development related to long term care/ Home and Community Based services


• Reports to Healthplan Medical Director with accountability to the local Choices Executive Director


• Leadership role in local clinical operations initiatives related to LTC Choices


• Manages external physician relationships, acts as community ambassador, and works with LTC Choices Executive Director in developing new business opportunities as required


• Responsible for Medicare- Medicaid coordination activities include: HBCS data sharing, Skilled nursing facilities data sharing, movement of eligible member back into the community from Skilled nursing facilities, and disease management to ensure cost-effectiveness


• Responsible for managing/monitoring the results of Care Management/ Health services interventions to ensure that utilization goals are achieved; collaborating with Care Management/ health services/behavioral health as necessary to maintain focus on achieving targets


• Develops new ideas for affordability initiatives in the population and drive their implementation when selected


• Supports local market data sharing activities include reviewing completed data analysis and establishing a process for sharing data with Skilled nursing facilities, HCBS providers and physicians


• Is responsible for complex case review with clinical staff and Choices care coordinators


• Support all Clinical Quality initiatives and peer review processes including QOC and QOS issues


• Provides support for all external audits by state and other regulatory agencies


• Act as liaison for network development of home and community service providers; potential vendor changes; gather market data; act as an improvement catalyst


• Communicate to providers on new focus and measure/process changes


• Deliver the clinical value proposition in support of the sales and growth activities of the Health Plan


• Promote positive relations with State/local regulatory authorities and Medical Societies


• Active participation in support of Joint Operating, QM, and PAS Committees.


• Coordinates care with the local integrated behavioral health teams Management

Required Qualifications:

• MD or DO with an active, unrestricted license


• Board Certified in an ABMS or AOBMS specialty


• 5+ years clinical practice experience -Intermediate or higher level of proficiency with managed care


• 2+ years Population Health or Quality Management experience

Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.SM

Diversity creates a healthier atmosphere: 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.


UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Job Keywords:Medical Director, ABMS, AOBMS, Managed Care, MD, DO, Population Health, Quality Management, Brentwood, TN, Tennessee