Medical Director - STARKids - Texas

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)

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. We'll put you in the driver's seat on vital projects that have strategic importance to our mission of helping people lead healthier lives. We need your organizational talents and business discipline to help fuel ours.

This position is responsible for leadership and execution of the Texas STAR Kids program (TX Medicaid managed care program for children with special health care needs).  The STAR Kids Medical Director has accountability for ensuring that health plan initiatives associated with the STAR Kids membership, and focusing on clinical excellence, quality ratings improvement, affordability, mandated provisions and compliance, growth and focused improvement, are implemented and successfully managed to achieve goals.

We're focused on improving the health of our members, enhancing our operational effectiveness and reinforcing brand and reputation for high-quality health plans. Join us and help guide our efforts to improve the patient experience. It takes passion, commitment, intense focus and the ability to contribute effectively in a highly collaborative team environment.

Key Activities:

• Reports to health plan Chief Medical Officer (CMO), with accountability to health plan's STAR Kids Executive Director (ED)


• Leadership role in local clinical operations and clinical quality initiatives related to STAR Kids


• Collaborates with CMO, ED, Vice President of Health Services, Senior Director of Quality Management and other health plan clinical and operations leadership to implement programs to support the STAR Kids membership and to meet health plan goals


• Works toward fully integrated clinical model, providing support and guidance to the STAR Kids Service Coordinators, and other clinical staff including transitional care management, disease management, and behavioral health teams


• Liaison to network management for physician and provider network development related to acute care and Home- and Community-Based services


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

Primary Responsibilities:

• Clinical Excellence-This medical director acts as an improvement catalyst for clinical quality efforts including state Pay-for-Quality program-related initiatives.  Facilitates value-based contracting processes by clinical data sharing with physicians and other providers.  Promotes implementation of accountable care communities (patient centered medical homes).  Responsible for complex case review with STAR Kids care coordinators and clinical staff.  Supports peer review processes including Quality of Care issues.  Serves as liaison for Network development of STAR Kids physicians and service providers.


• Affordability-This medical director ensures appropriate quality practices and utilization management from a macro view, for example, conducting hospital and physician practice Joint Operations Committee meetings jointly with Network Management, data sharing with physicians and physician groups on quality and efficiency improvement opportunities, and implementing local Health Care Affordability Initiatives.


• Relationship Equity-This medical director maintains a strong working knowledge of STAR Kids – relevant government mandates and provisions, working across the enterprise to implement and maintain compliant clinical programs and procedures.  Provides support for all external audits by state and other regulatory agencies.  S/he also is committed to being effectively engaged with our external constituents such as consumers/members, physicians, medical and specialty societies, hospitals and hospital associations, federal/state regulators, and market-based collaboratives. This commitment to regular, proactive dialogue will lead to collaboration around programs focused on improving health care to our members.

Required Qualifications:

• Physician with an active, unrestricted Texas medical license


• Board Certified in an ABMS or AOBMS specialty, with preference for Pediatrics or Pediatric Subspecialty, or Family Practice


• 5+ years clinical practice experience


• 2+ years experience with Managed Care, with Intermediate or higher level of proficiency; Medicaid managed care


• 2+ years Population Health or Quality Management experience

Demonstrable Skills and Experiences:

• Ability to lead a team that values organizational success over personal success; provide ongoing coaching and feedback to ensure peak performance


• Focus staff on the company's mission; inspire superior performance; ensure understanding of strategic context; set clear performance goals; focus energy on serving the customer; provide ongoing communication to the team; discontinue non-critical efforts


• Drive disciplined fact-based decisions


• Execute with discipline and urgency: Drive exceptional performance; deliver value to the customer; closely monitor execution; drive operational excellence; get directly involved when needed; actively manage financial performance; balance speed with analysis; ensure accountability for results


• Drive change and innovation though continually seeking and implementing innovative solutions; create a culture that thrives on continuous change; inspire people to stretch beyond their comfort zone; take well-reasoned risk; challenge "the way it has always been done"; change direction as required


• Model and demand integrity and compliance


• Proven ability to execute and drive improvements against stated goals


• Ability to develop relationships with network and community physicians and other providers


• Visibility and involvement in medical community


• Ability to successfully function in a matrix organization

UnitedHealthcare Community & State is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.

If you're ready to help make health care work better for more people, you can make a historic impact on the future of health care at UnitedHealthcare Community & State. We contract with states and other government agencies to provide care for over two million individuals. Working with physicians and other care providers, we ensure that our members obtain the care they need with a coordinated approach. This enables us to break down barriers, which makes health care easier for our customers to manage. That takes a lot of time. It takes a lot of good ideas. Most of all - it takes an entire team of talent. Individuals with the tenacity and the dedication to make things work better for millions of people all over our country.

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.