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Hours Full-time, Part-time
Location Houston, TX
Houston, Texas

About this job

Medical Director – Medical Management UnitedHealthcare Global
UnitedHealthcare Global Clinical Services (UHG-CS) conducts comprehensive, evidence-based and data-driven medical management activities for Global Insurance, Global Assistance, Global Markets and Global Medical businesses. The UHCG Medical Director serves as a key member of the UnitedHealthcare Global Team (UCHG) utilizing evidenced based practice to assess UHCG members’ medical care needs, treatment plans of healthcare providers and the ability of the local healthcare systems to provide high quality and cost effective care in various countries across the world. The UHCG Medical Director also works collaboratively with cross-functional team members to establish and implement plans for the patient’s safe evacuation to a location where appropriate care is available when it is determined that care needs cannot be met in the patient’s location. Working together with the clinical, network and operational teams, the Medical Director facilitates seamless provision of healthcare services to individual members helping them live healthier lives wherever they may be located across the globe. The Medical Director Unitedhealthcare Global reports directly to the Senior Medical Director, Unitedhealthcare Global. Specific Responsibilities: • Supports medical management of UnitedHealthcare Global members in both domestic and global healthcare environments. Supports providers, facilities and physician advisors in the global healthcare environment. Has a keen understanding of the cultural and operational challenges of global healthcare delivery. • Conducts reviews of global medical cases, including assessment and communication of case direction to the UHCG nurses and logistics specialist related to continued monitoring of care being provided locally or the need for evacuation. • Engages daily and ongoing with frontline UHCG clinical review nurses, reviewing cases electronically or in verbal case discussion, with the goals of achieving evidence-based and data-driven delivery of clinically appropriate and cost-effective care • Leverages evidence-based medicine, nationally recognized clinical guidelines and global healthcare standards to coach clinical staff and support providers in the provision of appropriate, high quality and cost-effective care in the domestic and global healthcare environment. • Concisely and articulately documents case review findings, actions and outcomes in electronic systems, and meets medical director inter-rater reliability and quality guidelines. • Regularly engages in peer-to-peer dialogue with practicing physicians and physician advisors about the care of individual inpatients to develop collaborative intervention plans based upon EBM. • Works collaboratively with international and domestic healthcare providers and internal clinical and operational teams to assure high quality cost-effective care management, proactive discharge planning, optimize reduce readmission risk and optimize patient health. • Initiates and maintains verbal and/or electronic communication with all appropriate stakeholders (patients, providers and clients) related to the status and action plans for the case. • Adheres to clinical documentation standards to ensure efficient case review, communication with team members and to facilitate timely and efficient determinations and claims adjudication. • Participates in the management of complex medical cases and collation of clinical information to assess and expedite assessment of care needs. This includes obtaining and reviewing verbal and written medical reports/records. • Pro-actively engages providers and physician advisors globally to review, discuss, and develop solutions for complex member situations. • Participates in routine team meetings, training and ongoing educational activities as well as policy and procedure development. • Engages in provider and facility quality assurance review, policy and procedure development as determined by business need. • Conducts high cost claims reviews for individual cases and engages in high cost claims reviews rounds. • Serves as a clinical educator and facilitates achievement of appropriate patient care goals through coaching of nurses and conducting peer-to-peer communication with practicing physicians globally. • As needed, participates in other utilization management activities driven by business need

Requirements

Requirements To be considered for this position, applicants need to meet the qualifications listed in this posting. • Unrestricted licensed physician; Board Certified in ABMS primary care specialty - required • 5 years clinical practice – required • 2 years experience with utilization management in payor and provider settings - required • Certification in utilization review or evidence-based guideline utilization - preferred • Experience in travel medicine and/or aeromedical services - preferred • Experience in clinical practice in global health arena or with global health emphasis - preferred • Excellent presentation skills for both clinical and non-clinical audiences • Strong sense of personal and professional responsibility • Flexibility and positive attitude essential • Excellent telephonic communication skills; excellent interpersonal communication skills • Proficient in utilizing basic Microsoft office tools such as Excel, Word, Power Point, Visio and other tools such as Macros • Experienced in working and documenting in multiple electronic patient information platforms • Proficient key-boarding skills required • Proficient in analysis and interpretation of clinical data sets • Foreign language skills considered a plus • Creative problem solving skills • Team player and team building skills • Proven success in change management • Proficiency in working in a matrix environment • Familiarity with current medical issues and practices • Exemplifies Our United Culture Already Fortune 6, we are totally focused on innovation and change. We work a little harder. We aim a little higher. We expect more from ourselves and each other. And at the end of the day, we're doing a lot of good.Through our family of businesses and a lot of inspired individuals, we're building a high-performance health care system that works better for more people in more ways than ever. Now we're looking to reinforce our team with people who are decisive, brilliant - and built for speed.Come to UnitedHealth Group, and share your ideas and your passion for doing more. We have roles that will fit your skills and knowledge. We have diverse opportunities that will fit your dreams.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.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.