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Administrative Medical Director, Medical Services - White Plains, NY or telecommute

Company: UnitedHealth Group
Location: White Plains
Posted on: September 23, 2019

Job Description:

OrthoNet is a proud member of the UnitedHeath Group family of companies and a leading orthopedic specialty benefit management company. OrthoNet works with more than 80,000 orthopedic health care providers, including specialists in orthopedic surgery, neurosurgery, podiatry, and physical, occupational, and speech therapy. Our mission is to achieve optimal outcomes for payors, providers, and members in a manner that combines efficient delivery of services, high quality care, and state of the art utilization and cost management tools. Join our team and together we can ensure the delivery of high quality, cost-effective care for our members and customers. The OrthoNet Administrative Medical Director of Operations provides leadership, organization, and direction for all utilization management programs and other Medical Department services as applicable.  Responsible for the overall quality, effectiveness and coordination of the utilization management and other managed care services provided through OrthoNet/Optum. Directs the Utilization Management program for the company/business unit, will oversee/direct/supervise the monitoring of utilization management and all other applicable managed care health services activities. This role provides direction and oversight in the development and implementation of clinical and administrative policies and procedures and any needed clinical criteria for all medical programs and services that are part of the Company’s programs. He/she will serve as the primary liaison between OrthoNet and other [UM] physicians; and OrthoNet and other medical service providers with whom we interact on health services and managed care programs. If you are located on the  East Coast for occasional commutable distance to the White Plains, NY office, you will have the flexibility to telecommute* as you take on some tough challenges. Primary Responsibilities: Monitors all relevant reports, information summaries, clinical and financial data relating to these activities and works with senior management to further improve overall company performance. Provides direction for development and implementation of new utilization management, population health, provider and member integrated health care operations and other activities Oversees the development and implementation of policies and procedures to ensure effective monitoring and management of managed care activities. Oversee implementation of a risk assessment process for the member population/population health programs and other innovative health care activities. Participation in Training regarding URAC, NCQA, CMS and other Regulatory Compliance. Represents OrthoNet in broader company activities and program development as required Provides guidance for programs in payment integrity and professional/other services claim coding. Chairs/Serves on utilization management Advises and assists the credentialing activities required for physician and physical therapy networks as needed Assists the Provider Relations, customer service and other staff with resolving provider and payor issues including, but not limited to clinical inquiries, claims issues, fee schedule concerns, medical policies, procedures and member/provider appeal coordination Maintains liaison relationships with payors and providers in the community as required Serves as the primary contact with clients/managed care clients and participating providers regarding OrthoNet [UM related] activities Represents OrthoNet as required in other company business Monitors compliance with regulatory agency standards and requirements (i.e. CMS, NCQA, URAC, state/federal and third party payors) Required Qualifications: M.D. or D.O. degree Post-graduate experience in clinical medical practice/patient care is essential Current, active and fully unrestricted Medical license(s) in US state(s) Active Board certification required in ABMS-recognized specialty 5+ years previous experience in a progressive, results-oriented managed care environment, quality improvement, and utilization management and case management experiences 10+ years of experience in clinical medical practice essential Specific familiarity with managed care accreditation activities and NCQA, URAC, CMS, state and other federal regulations. MS Office (MS Word, Excel, and Power Point) Preferred Qualifications: Experience with integration of clinical and financial data, development of utilization and performance reporting tools, and communication of performance data to physicians and other health care providers. Excellent verbal and written communication skills Diplomacy and tact in dealing with sensitive issues Must possess leadership skills in working with other physicians and non-physicians, knowledge of the overall medical community and the local/regional managed care environments. ABMS specialty preferably with musculoskeletal emphasis Strong abilities and experience in large size health care organizations that are geographically widely distributed and heavily virtual (“remote workers”) Demonstrated ability in developing and internally marketing concepts for program improvement and program development Ability and experience in relating to individuals at many levels of large organizations Experience in presenting/selling programs to potential clients Experience in maintaining relationships with existing clients even in situations of potential disagreements Transforming health care and millions of lives starts with the values you embrace and the passion you bring. Find out more and join us. It's an opportunity to do your life's best work.(sm) 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 *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: Medical license, MD, leadership, UM, utilization management, White Plains, NY, New York, Hartford, CT, Connecticut, Newark, NJ, New Jersey, Pittsburgh, PA, Pennsylvania, Boston, MA, Massachusetts, telecommute

Keywords: UnitedHealth Group, Trenton , Administrative Medical Director, Medical Services - White Plains, NY or telecommute, Other , White Plains, New Jersey

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