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　　At Optum, we are transforming healthcare nationally while providing physician-led care locally. Work with the largest care delivery organization in the world and start doing your life’s best work.(sm) We are passionate about patients and are leading the state of California toward better healthcare practices. Optum- NAMM is a close-knit team that has been long-respected in Southern California.

　　As part of our continued growth, we have a new opportunity for a Medical Director to join our leadership team based in San Diego County.

　　Job Overview:

　　Accountable for clinical and administrative leadership to the clinicians within their region. Collaborate with Physicians, Advanced Practice Clinicians, IPA and employed teams to ensure that patient needs are met, and responsible for many Medical Management functions. Assist with oversight and development for major programs and functional areas within an IPA and employed setting including medical policy review and development; population management and reporting functions. Work with physicians and other providers to improve the quality and efficiency of care in the network. Accountable for the KPI performance of employed clinics and IPA physicians within region of responsibility.

　　Position Highlights:

　　Works primarily with the physician community around issues of patients, balancing business, and clinical concerns

　　Provides limited utilization management for outpatient medical, surgical and pharmacy activity. Participates in medical appeals activity. Work with the Appeals unit on appeals related to utilization management issues

　　Provides medical leadership and physician advice to the quality management area with respect to quality improvement studies, quality improvement committees, primary care assessments.

　　Performs peer reviews on quality complaints, sentinel events, and quality-of-care referrals

　　Serves as Physician Advisor for other areas within the company, including but not limited to Sales and Marketing, Underwriting, and Provider Services.

　　Provides medical leadership and advice for conformance with standards and guidelines for NCQA (National Committee for Quality Assurance), URAC (Utilization Review Accreditation Commission), state and federal regulators, and other accrediting bodies. Acts as liaison for communication with physicians, hospitals, and other providers in the community.

　　Act as the Clinical Lead for Risk Adjustment and works collaboratively with the Risk Adjustment team, regional leadership and physicians to improve the accuracy and completeness of coding and documentation.

　　Engages with the employed and IPA physicians and practices to implement strategies to improve the completion rate of annual wellness visits. Collaborates with the Quality team employed and IPA physicians and practices to implement strategies to improve Quality STARs measures.

　　Participates in affordability strategies to include inpatient management, outpatient high risk management, site of service and specialty contracting opportunities. Assist with coverage of Medical Directors in areas of review and IDT (Interdisciplinary Team) conference management as needed.

　　Collaborates with operations dyad partners to achieve goals set by senior leadership including but not limited to quality measures, risk adjustment, affordability, and access.

　　Compensation & Benefits Highlights

　　Competitive starting salary and bonus options

　　401k with match, Executive Savings Plan, and UHG Employee Stock Purchase Program

　　Comprehensive Benefits: Health, Vision, & Dental

　　Continued professional growth & leadership opportunities

　　Required Qualifications:

　　Current and unrestricted MD or DO license in California

　　Board certification in chosen specialty

　　5+ years of experience in clinical practice

　　3+ years of experience working as a Medical Director in a managed care setting

　　3+ years of experience interacting with both group and IPA Physicians

　　Experience with and comfort level in supervising Advanced Practice Clinicians

　　Preferred Qualifications:

　　Presentation skills

　　EMR experience

　　For California Residents Only: The salary range for California residents is $248,582.00 to $338,965.00 per year. Salary Range is defined as total cash compensation at target. The actual range and pay mix of base and bonus is variable based upon experience and metric achievement. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

　　Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.

　　OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.