Community & State Medical Director - Texas Medicaid

Company: UnitedHealth Group
Location: Houston
Posted on: November 20, 2023

Job Description:

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. - -For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. We'll put you in the driver's seat on vital projects that have strategic importance to our mission of helping people lead healthier lives. We need your organizational talents and business discipline to help fuel ours. -UnitedHealthcare's Medicaid health plan in Texas is experiencing substantial geographic expansion and membership growth in light of our recent successful re-procurement award by the state Medicaid regulator. The Medical Director is responsible for clinical leadership and execution of the Texas Medicaid managed care programs, in collaboration with the health plan Chief Medical Officer and health plan medical director colleagues. -The Medical Director has accountability for ensuring that health plan initiatives associated with the Medicaid membership, and focusing on clinical excellence, quality ratings improvement, affordability, mandated provisions and compliance, growth and focused improvement, are implemented and successfully managed to achieve goals.We're focused on improving the health of our members, enhancing our operational effectiveness and reinforcing brand and reputation for high-quality health plans. Join us and help guide our efforts to improve the patient experience. It takes passion, commitment, intense focus and the ability to contribute effectively in a highly collaborative team environment.Key Activities:

• Reports to health plan Chief Medical Officer (CMO), with accountability to health plan's Executive Directors of the STAR+PLUS, MMP, STAR Kids, and STAR and CHIP teams
• Leadership role in local clinical operations and clinical quality initiatives -
• Collaborates with CMO, Senior Health Services Director and Director of Clinical Operations, Senior Director of Complex Care Management, Senior Director of Quality Management and other health plan leaders to implement programs to support the membership and to meet health plan goals
• Works toward fully integrated clinical model, providing support and guidance to service coordinators and care managers, and other clinical staff including transitional care management, disease management, and behavioral health teams
• Liaison to network management for physician and provider network development related to acute care and Home- and Community-Based services
• Manages external physician relationships, acts as community ambassador, and works with Executive Directors in developing new business opportunitiesIf you are located in Texas, you will have the flexibility to work remotely* as you take on some tough challenges. - -Primary Responsibilities: -
  • Clinical Excellence - This medical director acts as an improvement catalyst for clinical quality efforts including state Pay-for-Quality program-related initiatives. -Facilitates alternative payment models with providers by clinical data sharing and strategy recommendations with physicians and other providers. -Promotes implementation of accountable care organizations. -Responsible for complex case reviews with care coordinators and clinical staff, including leadership of medical-behavioral integrated care conferences and leadership of various interdisciplinary team meetings. -Reviews individual member care plans and provides suggestions to better meet the members' needs. -Interacts with members' providers as needed to support care management. Provides training to health plan clinical staff. -Provides guidance to utilization management decision makers on case reviews. Supports peer review processes including Quality of Care issues. -Engages in state Fair Hearings as required. -Serves as liaison for Network development. -Holds internal and external stakeholders accountable for their roles in the Care Continuum by supporting health plan quality of care and medical expense management
  • Affordability - This medical director ensures appropriate quality practices and utilization management from a macro view, for example, conducting hospital and physician practice Joint Operations Committee meetings jointly with Network Management, data sharing with physicians and physician groups on quality and efficiency improvement opportunities, and implementing local Health Care Affordability Initiatives
  • Relationship Equity - This medical director maintains a solid working knowledge of relevant government mandates and provisions, working across the enterprise to implement and maintain compliant clinical programs and procedures. -Provides support for all external audits by state and other regulatory agencies. -S/he also is committed to being effectively engaged with our external constituents such as consumers/members, physicians, medical and specialty societies, hospitals and hospital associations, federal/state regulators, and market-based collaboratives. This commitment to regular, proactive dialogue will lead to collaboration around programs focused on improving health care to our membersDemonstrable Skills and Experiences: -
    • Ability to lead a team that values organizational success over personal success; provide ongoing coaching and feedback to ensure peak performance
    • Focus staff on the company's mission; inspire superior performance; ensure understanding of strategic context; set clear performance goals; focus energy on serving the customer; provide ongoing communication to the team; discontinue non-critical efforts
    • Drive disciplined fact-based decisions
    • Execute with discipline and urgency: Drive exceptional performance; deliver value to the customer; closely monitor execution; drive operational excellence; get directly involved when needed; actively manage financial performance; balance speed with analysis; ensure accountability for results -
    • Drive change and innovation though continually seeking and implementing innovative solutions; create a culture that thrives on continuous change; inspire people to stretch beyond their comfort zone; take well-reasoned risk; challenge "the way it has always been done"; change direction as required -
    • Model and demand integrity and compliance -
    • Proven ability to execute and drive improvements against stated goals
    • Ability to develop relationships with network and community physicians and other providers. -
    • Visibility and involvement in medical community -
    • Ability to successfully function in a matrix organization, exhibiting the culture of UnitedHealth Group - - -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: -
      • Active/unrestricted Texas Medical License
      • Board Certified in an ABMS or AOBMS specialty
      • 5+ years of clinical practice experience
      • 2+ years of experience in a Managed Care organization, with Intermediate or higher level of proficiency; Medicaid managed care experience preferable -
      • 2+ years of Population Health and/or Quality Management experience*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy - - - -At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. - - - - -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. - -

Keywords: UnitedHealth Group, Houston , Community & State Medical Director - Texas Medicaid, Executive , Houston, Texas