Medical Director Long Term Services and Support , Des Moines, IA - Relocation Offered - Full-time / Part-time

Reporting to the CMO of the UnitedHealthcare Community Plan of Iowa.
Primary Responsibilities:

Performs daily review of personal care attendant services to approve or deny appropriate services for members
Will work with nursing staff to clarify requests and documentation as needed
Leads on-site flu initiative and workgroup
Responsible for appropriate utilization management including 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
Participates in healthcare affordability initiatives and meetings at the local market
Conducts provider telephonic review and discussion, schedules on-site visits and shares tools, information and guidelines related to cost-effective health care delivery and quality of care as necessary
Participates in the HEDIS data collection process, CAHPS (Consumer Assessment of Healthcare Providers and Systems) improvement, and drive Health Plan accreditation activities
Supports all clinical quality initiatives and peer review processes
Effectively engages and brings understanding to our external constituents such as physicians, medical and specialty societies, hospitals and hospital associations, and state regulators
Provides support for all external audits by state and other regulatory agencies
Works toward fully integrated clinical model working with Behavioral Health and  clinical management
Responsible for identifying opportunities through participation in local medical expense committees or market reviews
Collaborates with the health plan Chief Medical Officer, and other clinical staff as a clinical resource and coach to establish and implement programs to support and meet the UM goals
Collaborates with the health plan Chief Medical Officer, clinical operations staff, and other market staff to implement programs to support and meet market and national clinical operations goals
Accountable for providing clinical leadership primarily focusing on home and community based services review and external communication with network physicians
May assist in the development and implementation of local plan clinical policies and procedures, quality improvement activities and performance improvement projects

Required Qualifications:

MD or DO with an active, unrestricted license
Board Certified in an ABMS or AOBMS specialty
5+ years clinical practice experience, preferably in geriatric medicine
Intermediate or higher level of proficiency with managed care
2+ years 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.