LTSS Medical Director - UHC Community Plan of New Mexico

What makes your clinical career greater with UnitedHealth Group?  You can improve the health of others and help heal the health care system.  You can work within an incredible team culture, a clinical and business collaboration that is learning and evolving every day, and, when you contribute, you’ll open doors for yourself that simply do not exist in any other organization, anywhere.
 
Reports to the CMO of the UnitedHealthcare Community Plan of New Mexico. 
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
Responsible for appropriate utilization management including managing / monitoring the results of Care Management / Health services interventions to ensure that utilization goals are achieved  including NFLOC, Emod and SDCB reviews, LTSS determinations and trainings
Collaborates with Care Management / health services / behavioral health as necessary to maintain focus on achieving targets
Participates in healthcare affordability initiatives at the local market
Leads the following initiatives:

Pharmacy / Provider Lock-in  which includes 4 quarterly meetings and administrative work
Lead - Self Directed Community Benefit

Monthly Touchpoints with Support Brokers - now 6 agencies
Biweekly meeting with internal SDCB team
Biweekly meeting with SRT for SDCB process
Self Directed Community Advisory Board
Provider Advisory Committee in conjunction with the BH Medical Director - including coordinating meetings and seeking  new  provider members
State LTC Workgroup
Administrative Burden Reduction Task Force
DDW / MCO Care Coordination Work Group
NurseLine
Lead LTSS VABs, PCS Incentives including  seeking LTC VBC opportunities 
Provides support for all external audits by state and other regulatory agencies
Review and Analyze  of  Health Plan State Reports due Monthly, Quarterly, Annually as required
Executive Lead Meeting with Ken Smilth on LTSS
National Meetings including West Regional and National C&S Medical Directors, Credentialing Committee, Regional Peer Review
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
Works within our fully integrated clinical model working with Behavioral Health and  clinical management
Responsible for identifying opportunities through participation in local  and national LTSS medical expense committees or market reviews

Required Qualifications:

MD or DO with an active, unrestricted license in New Mexico
Board Certified in an ABMS or AOBMS specialty or ability to obtain Board Certification
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: 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.