Medical Director, Complex Care - Upstate NY - Rochester preferred - Full-time / Part-time

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This Medical Director is a member of the Senior Leadership Team (SLT) of the Upstate New York, Optum Complex Care Management team. They will work with SLT to develop and drive the business strategy, growth and clinical operations and help to ensure that the highest level of quality care is being delivered to the residents of our partner nursing homes. This individual will work collaboratively with the sites advanced practice clinicians and will serve as a clinical resource when needed.  As the site Medical Director this position is recognized as the clinical ‘face of the business’ related to the clinical and business communities.  The Medical Director will have oversight of 62 contracted nursing homes in Jamestown, Buffalo, Rochester, Syracuse Utica and Albany.

Primary Responsibilities:


Achieve sustainable, profitable growth via new business development and Growth

Promote the clinical and financial value propositions to new business and current partner stakeholders to achieve growth goals

Coordinate and facilitate the orientation of all new PCPs to the model

Routinely meet with currently collaborating PCP’s

Collaborate with Business Development team to identify potential SNFs / Provider Groups with new membership opportunities

Engage and speak with state and local organizations, LTC industry associations, medical society memberships, etc. regarding value and quality outcomes of the models

Develop and sustain strong relationships with other medical directors and health care system leaders in market territory

Actively engage NP / PA clinical staff with didactic, written and 1:1 education on geriatric syndromes, chronic illness, SNF regulations, and end of life / palliative care

Assist in quality of care concern case reviews and corrective action plans

Develop and revise clinical practice standards and procedures

Fulfill requirements for SNP Model of Care; State; and Federal regulations

Leadership role for achievement of targets for market or contract specific STAR; HEDIS measures; and Quality Improvement Programs

Lead market review and develop education and operational plans to address pharmacy , acute hospitalization, skilled SNF services, DME, and physician medical expense

Provide leadership accountability for ensuring accuracy of all documentation and coding

Educate NP / PA staff in use of coding tools and documentation requirements

20-30% day travel within Upstate NY

Requirements:
 

MD or DO in State of NY
ABMS Board Certified in: Internal Medicine, Family Practice, Geriatrics or Hospice/ Palliative Care 
Minimum of 5 years of geriatric and long-term care experience
Demonstrated experience working with and educating NP’s and PA’s 
Preferred skills:
 

Health care management/leadership experience
CMS, Medicare Advantage, SNP Rules and Regulations
HCC and Risk Adjusted reimbursement methodology
Inpatient / SNF utilization metrics and bed day management
Financial Reports: Revenue; Expenses; Contribution Margin; Budgeting & Forecasting; BCR; IOI
State specific collaborative practice agreements and midlevel practitioner licensing
Working knowledge of EMR structures

UnitedHealth Group is working to create the health care system of tomorrow. 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.
 
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