National Accounts Medical Director - Minnesota Telecommute

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We are currently seeking a National Accounts Medical Director to sit in our Eden Prairie, MN office for 3 days a week. The Medical Director will take a member centric approach to help the health system work better and to promote best in class care management. This includes meeting with external stakeholders, program and product design improvement, site related audits and improvement initiatives.

This role has three core functions:

As the team's clinical leader, Medical Directors:
  • Promote and communicates the mission, vision, business strategy and OPTUM value proposition to the staff through leadership meetings, educational programs and documents, program and tool development, and case discussions.
  • Work closely with Site Directors and Operations Product and Channel Leads to meet site, channel, and product goals.
  • Provide leadership, training and coaching for nurses in:

As Case Reviewer, Medical Directors:
  • Perform peer to peer discussions when indicated which promote optimal health and well-being of the individual.
  • Through one-on-one discussions as well as Medical Director Value Case Reviews with nursing staff, stimulates critical thinking, assists in identification of clinical gaps, and coach staff on communication with providers and on care plan development;

As "Physician Liaison", Medical Directors:
  • Interact with Regions, Markets, Customers, and other UHG Medical Directors, Sales, Account Management, Clinical Solutioning, Health Plan Medical Directors, Network Management, and OptumHealth partners to implement strategy implement products and programs, acquire and retain customers, and improve the quality and outcomes of the consumers navigating care delivered by the provider network and to improve relationships between the organizations.
  • Attend Monthly Medical Expense Meetings by Region and assist with regionally based Affordability Initiatives with a focus on admission, readmission overall bed day management
  • Understand and act upon Condition Specific drivers including high cost claimants and consumers with a pattern of frequent utilization

If you are located in Eden Prairie, Minnesota area, you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:
  • MD Lead of is an integrated comprehensive clinical model
  • Daily BCRT rounds; integration with Optum RX, Briova, Behavioral, CCR, ICM and Advocates
  • Customer Specific Predictive Model with new ID Strat Rules. (Hub Rules)
  • Support Leadership visits to the Hub throughout the year
  • Support for RFP's
  • Customer Specific VDA report, access to HCTA, PBC reporting, Hospital Cost Report for analyzing trends and calculating savings
  • Automation projects for the Hub include Shewart Charting (Control Charts), BCRT Extract Tool and Proactive Outreach by CIDM for Denials Tool and Process
  • To-date Savings Calculations for the Hub
  • Managing Catastrophic Claimants
  • Coordination of Benefits
  • Subrogation coordination
  • Address escalated issues from the customer's HR and benefits team
  • Assist with benefit design
  • Individual Case Review and Peer to Peer and Peer to Consumer calls as needed
  • Alignment of the customer's culture with Our United Culture across the Hub
  • Ensure benefit determinations are consistent with plan desires and are consumer centric
  • Manage to trend guarantee
  • Participate in larger quarterly MCAP activities and drive the Small Group MCAP for customer specific savings or process improvement opportunities
  • Compile and compose success stories
  • Cascade learnings to other teams through the value story and playbooks
  • Support for the Special Needs Initiative
  • Position is on-site minimum of 3 days per week

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:
  • MD or DO with an active, unrestricted medical license in the state of Minnesota
  • Current Board Certification in an ABMS or AOBMS specialty
  • 5+ years clinical practice experience
  • Must be onsite at our Eden Prairie, MN office a minimum of 3 days per week
  • Proven project management skills
  • Data analysis and interpretation skills; ability to focus on key metrics
  • Proficiency with Microsoft Office applications
  • Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance.

Preferred Qualifications:
  • 2+ years managed care, Quality Management experience and / or administrative leadership experience
  • Prior experience with UM and CM
  • Prior Medicaid experience a plus

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies now require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles require full COVID-19 vaccination as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care 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)

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

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.

Job Keywords: National Accounts Medical Director, Medical Director, utilization review, project management, clinical, Telecommute, Telecommuting, Telecommuter, Work From Home, Remote, WFH, Eden Prairie, MN, Minnesota