Senior Medical Director, CDQI - Denver, CO

Careers at UnitedHealth Group

We're creating opportunities in every corner of the health care marketplace to improve lives while we're building careers. At UnitedHealth Group, we support you with the latest tools, advanced training and the combined strength of high caliber co-workers who share your passion, your energy and your commitment to quality. Join us and start doing your life's best work. SM


Compassion. It's the starting point for health care providers like you and it's what drives us every day as we put our exceptional skills together with a real feeling of caring for others. This is a place where your impact goes beyond providing care one patient at a time. Because here, every day, you're also providing leadership and contributing in ways that can affect millions for years to come. Ready for a new path? Learn more, and start doing your life's best work. SM

Our teams are helping people from around the world. We can bring out your best as you put your listening, analytical and problem solving skills to work in a setting that is geared to helping improve lives and enhance health care for millions. Here, you'll discover a wealth of pathways for professional growth within Customer Service, Billing, Claims, Enrollment & Eligibility and across our global economy. Join us and find out why this is the place to do your life's best work. SM

OptumCare Colorado is a physician-led, close-knit team that's been long respected in the Colorado community. We're passionate about patients. We're leading the State of Colorado towards better healthcare practices. And we're looking for amazing doctors like you. We have 23 clinics and 117 providers. As a nationwide family: You'll have the full strength of Optum behind you, including our breakthrough research and our vast experience as a national leader delivering local care, with over 39,000 physicians in over 1200 clinics.

The Senior Medical Director, Coding Accuracy and Documentation will lead strategy, education and hold accountability for risk adjustment performance at the OptumCare Colorado Market level. Strategy planning and deployment consists of developing EOY performance targets, monitoring variance to glidepath on a week-over-week, month-over-month basis, and developing tactics and programs to meet forecast. Tactics and programs may include but not limited to coordination with finance on incentive planning, total provider and staff education on coding accuracy and documentation, review of individual provider performance, provider-to-provider mentoring, development of new member cohort program. This role will have first-level oversight and accountability over BUR market performance. This is an 80% administrative position with 20% clinical patient care.

Primary Responsibilities:
  • Participation in the strategy planning and performance assessment of Medicare Part C population, inclusive of SNP population if applicable, and Commercial and Medicaid Risk if applicable. Performance assessment includes metrics dashboard on coding and quality initiatives.
  • Development of system wide programs for improving provider, clinic and organizational performance in Risk. This may include design and financial return on investment proposals. As an example: Annual Wellness Program.
  • Subject Knowledge expert on Risk adjustment coding and adult learning education
  • Development and implementation of specific education programs for all provider and staff levels, including coding and documentation requirements, workflows, and performance metrics.
  • Objective evaluation of current state metrics with ability to dissect, identify gaps, pivot, and develop countermeasures as necessary
  • Coordination on coding efforts with OptumCare Colorado senior leadership, primary care and specialty leadership, IPA leadership and other stakeholders
  • Provides medico-administrative leadership.
  • Intimate familiarity with all provider-facing aspects of population health of Medicare advantage patients and metrics associated with above, inclusive of provider decision support EMR tools
  • Risk adjustment liaison between the OptumCare Colorado leadership, Mountain West Regional leaders, and OptumCare Clinical Performance
  • Work in conjunction with Healthcare Economics team on risk reporting tools for providers, clinic and company wide use as needed
  • Work in conjunction with Mountain West Certified Coder team on compliance and areas of improvement
  • Work in conjunction with Clinical and Operations Leadership to develop programs and workflows
  • Meets regularly with providers (individual or team-based) to develop relationships, trust, and assessment of needs
  • Maintain lens toward a reliable and consistent provider experience and elimination of waste within provider workflow
  • Work collaboratively with Health Informatics, Coders, Finance, Quality/STAR, Affordability team
  • Continuously alert for new and innovative approaches towards population health, changes to coding accuracy regulations

Required Qualifications:
  • M.D. or D.O. with board certification in a medical specialty.
  • Licensed to practice by the Colorado Medical Board.
  • Practice within a medical specialty group for at least 5 years.

Preferred Qualifications:
  • Additional training in Coding and Quality Improvement desirable.

The salary range for Colorado residents is $293,200 to $324,800. 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.

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity 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.

Job Keywords: Senior Medical Director, Clinical, Doctor, Managed Care, Physician, Clinician, CDQI, Coding Accuracy and Documentation, Colorado, Denver