National Medical Director, Medical Management

  • UnitedHealth Group
  • Remote
  • Nov 16, 2021
Physician Any Specialty

Job Description

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

.UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the healthcare industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm)

This position will report to the Chief Medical Officer of UnitedHealthcare and will be responsible for the Medical Management program to ensure care is safe, effective and affordable.  The UnitedHealth Care Clinical Services National Medical Director will work with leaders across the enterprise to evaluate and build the medical program value proposition with a focus on inpatient care management, prior authorization, and discharge planning.   This role will assume oversight and drive execution with Optum Enterprise Clinical Services as well as Optum MBM to reduce denials, improve member care, NPS and provider abrasion.  The National Medical Director will review, evaluate, advise and drive clinical programs presented by all lines of business, including delegation with internal affiliates and external entities.  The National Medical Director will chair the UM Program committee and site on the Delegation Oversight Committee. 

The National Medical Director will work closely with the UCS leadership teams in UM Modernization, Value Creation and Business Standardization.  This role will be a critical part of the UCS leadership team and will hold delegate decision making authority on behalf of the Chief Medical Officer of UnitedHealthcare. The National Medical Director will require a strategic mindset with the ability to handle multiple priorities as well as the ability to articulate and represent both UHC and Optum’s strategy to executive leaders across the enterprise and external partners.  

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

  • Utilization review, risk management, and quality assurance of medical programs in order to ensure the judicious use of the facility's resources and high-quality care
  • Comprehensive utilization review containing three types of assessments: prospective, concurrent, and retrospective
  • Responsible for developing and executing the clinical strategy and programs to maximize health care quality
  • Analyzes the company’s health care claims data, medical literature, clinical experience and customer feedback to identify future programs
  • Accountable for post-deployment measurement of result
  • Demonstrate the ability to envision creative, workable solutions
  • Quantitative analysis and evaluation of data sets and/or development of research methods to evaluate a problem and recommend data driven solutions
  • Establish the financial viability of programs; recommend changes as applicable
  • Qualitative analysis and strategic problem solving
  • Articulate and represent both UHC and Optum’s strategy to executive leaders across the enterprise and external partners
  • Communicate with executives in decision-making, program management and initiative implementation
  • Makes recommendation to improve current processes and coordinates organizational procedures for optimized efficiency and productivity
  • Build and develop relationships across teams to ensure effective feedback loops and that deliverables are met
  • Advises leadership on improvement opportunities regarding medical expense programs and clinical activities that impact medical expense

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:

  • Licensed physician; Board Certified
  • ABMS specialty preferred
  • 10+ years clinical practice experience inclusive of managed care experience
  • Deep bench with national experience with a track record of designing, implementing, executing and reviewing Medical Management programs
  • Extensive record of performance, by meeting and exceeding operational goals in health care quality and cost management
  • Proven success in change management and innovation
  • Proficiency in working in a matrix environment
  • Strategic thinking with proven ability to communicate a vision and drive results
  • Data analysis and interpretation skills
  • Ability to focus on key metrics
  • Demonstrated ability to make strategic, operational and administrative decisions in response to emerging conditions and environmental circumstances
  • Proven ability to drive, lead and communicate change effectively in a fast-paced environment and be adaptable within the changing environment
  • Ability to provide recommendations and insight regarding improvements to internal and external processes
  • Ability to manage programs and projects in a strategic and professional manner
  • Ability to manage and support organizational change and help assist individuals through the transition
  • Strong ability to communicate effectively and efficiently (both verbal and written) at multiple levels of large, complex organizations
  • Motivate and influence others at all levels within the organization
  • Demonstrated ability in systems thinking and enterprise insight to solve complex business problems and strong analytical skills with ability to drive transformational, consumer – centric change and manage long – term programs

UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 7 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that’s second to none. This is no small opportunity. It's where you can do your life's best work.(sm)

Colorado, Connecticut or Nevada Residents Only: The role is also eligible to participate in UHG’s annual bonus and long term incentive plans. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, in addition to your salary,  UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.

*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.