Medical Director,Quality & Performance Improvement - Monarch, Irvine, CA - Full-time / Part-time

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 Medical Director of Quality & Performance Improvement is a key position within Monarch HealthCare. This position works collaboratively with other Medical Directors in Clinical Services to ensure the goals of the Quality Management program, Risk Adjustment program, and ACO program(s) are being met. Internally and externally, the Medical Director is viewed as the physician Champion for all three areas. This position chairs Monarch?s Quality Management Committee, the Performance Improvement Committee, and sponsors the Credentialing and Peer Review Committee. This physician is the company representative at health plan, Optum Collaborative Care and industry meetings.

The Medical Director works collaboratively across all levels and departments within the company. This position is part of a Medical Director team within Clinical Services that . works collaboratively with the Clinical Services Directors, and the Vice President of Clinical Services to develop strategy and execute the strategic initiatives. In addition, this Medical Director represents Monarch in its Accountable Care Organization relationships, working closely with the Executive Director, ACO.

The Medical Director of Quality & Performance Improvement is a highly visible position within the company and to the external Network. The Medical Director must have significant knowledge of the Clinical Services department's activities related to department initiatives. The leadership role that the Medical Director of Quality & Performance Improvement fills requires an understanding the overall goals of the department and to provide leadership in the practical integration of Quality and Performance Improvement, risk adjustment and ACO goals into clinical initiatives.

Primary Responsibilities:

• Responsible for oversight of Monarch HealthCare's Quality Management program


• Works closely with the Manager of Quality and Performance Improvement to ensure the program meets all regulatory requirements and is accurately modified when requirements change. Annual approval of the QM program description and annual updates are sent to the Board of Directors for approval


• Leads the Performance Improvement team, working closely with the Director of Performance Improvement, to ensure top tier performance in HEDIS, P4P and CMS Star


• Responsible for annual strategic planning to achieve team goals


• Oversees Risk Adjustment and HCC Coding Initiatives including the development, education, and promotion of Risk Adjustment Initiatives, working closely with the Associate Vice President, Risk Adjustment


• Chairs the Quality Management Committee, sponsors the Credentialing and Peer Review Committee, and the Performance Improvement Committee


• The Medical Director is accountable to collaborate with other Medical Directors to bring forth improvement opportunities that enhance quality, efficiency, and risk adjustment coding, and ACO performance in their respective areas


• Works closely with Network Management and Performance Improvement Committee to promote initiatives to enhance provider and patient satisfaction and the development of provider performance indicators


• This visible position represents Monarch HealthCare in industry collaborative efforts and external organizations to promote Monarch's quality and clinical care programs


• The Medical Director must have a collegial relationship with IPAnetwork physicians and Optum Medical Groupin order to promote understanding and successful implementation of Performance Improvement efforts related to HEDIS, P4P and CMS Star, Risk Adjusted Coding, and top tier ACO performance.  This may take the form of group meetings and/or 1:1 physician meetings


• This Medical Director will educate Monarch staff as needed in the areas of Quality Management, Risk Adjustment and ACO efforts


• This position is the Monarch Medical Director who will interface with Optum Collaborative Care in meetings and Optum strategic planning for Quality (HEDIS, CMS Star), Risk Adjustment and ACO efforts


• Other duties and responsibilities as assigned by the CMO, President and officers of Monarch HealthCare


• Regular and consistent attendance
  

Required Qualifications:

• Graduated from a national accredited School of Medicine or Osteopathy; a doctoral degree (MD or DO); greater than 5 years related experience and / or training; or equivalent combination of education and experience


• Have at least 3 years of clinical practice in direct patient care


• 3+ years medical management or administrative experience in a managed care setting


• Possess sufficient clinical knowledge to interact with the physician members of the IPA in all major medical specialties


• Proven track record of quality leadership and exceptional teamwork in order to build and foster stellar working relationships in both Clinical and Operational departments


• The Medical Director must hold a valid, unrestricted license to practice medicine in the State of California


• Board certification in their chosen specialty


• Current and valid California driver's license and insurance to operate vehicle

Preferred Qualifications:

• Demonstrated ability to lead teams, propose innovative and practical solutions is desirable

What's the first thing that happens when one of the most successful physician groups in Orange County comes together with a global leader in health care? Opportunity. With Monarch HealthCare joining Optum and the UnitedHealth Group family of companies, people like you will find increasing levels of challenge, impact and professional success. With a vibrant network of hospitals and urgent care centers, we're changing health care for the better by improving access to affordable, high quality care, and working together to improve the patient experience. That takes passion, commitment, intense focus and the ability to contribute effectively in a highly collaborative team environment. Are you with us? Learn more about this exciting opportunity 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.