Medical Director, Complex Care Management

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Company: UnitedHealth Group
Location: Phoenix, AZ 85003

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Medical Director careers with UnitedHealth Group is anything but ordinary. We push ourselves and each other to find smarter solutions. The result is a culture of performance that’s driving the health care industry forward. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Join us. And start doing your life’s best work. (sm)

Reporting to the Regional Medical Director, this Medical Director is a member of the Leadership Team for the Optum Complex Care Management team. They will work with the Senior Leadership team to develop and drive the business strategy, growth, and clinical operations in the market. The Medical Director will 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 site’s advanced practice clinicians and will serve as a clinical resource when needed. The Medical Director does not provide direct patient care, but rather is recognized as the clinical “face of the business” related to the clinical and business communities. The Medical Director will interface with contracted nursing homes across the market, collaborating with a Medical Director partner.


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 PCPs
  • 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 and State and Federal regulations
  • Achievement of targets for market or contract specific STAR and 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
  • 30 – 40% day travel

Metrics / Goals:
  • Admits per 1000 (APK, APT)
  • Readmissions
  • SNF day’s utilization
  • Key Medical Expense Metrics / Medical Expense Management
  • Overall Plan STAR Rating and individual STAR / HEDIS measures for each patient
  • Appropriate documentation and coding to attain an accurate Risk Adjustment Factor (RAF) for each patient


Required Qualifications:
  • MD or DO license in the state of AZ or UT
  • ABMS Board Certified in Internal Medicine, Family Practice, Geriatrics, or Hospice / Palliative
  • 5+ years of experience working with geriatric or long – term care population
  • Demonstrated experience working with and educating NPs and PAs
  • Position will require frequent travel between UT and AZ markets

Preferred Qualifications:
  • 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

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)


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.