Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.
The Optum Medical Director is responsible for driving quality care to all Optum SLCo members in the right place at the right time. The Medical Director monitors the treatment of specific members in any level of care. She is responsible for conducting peer reviews when a care advocate advises a member no longer meets the level of criteria per LOCUS, CASII and ESCII. She engages in case staffing twice weekly to ensure inpatient behavioral health care is progressing and the inpatient team is using medical and psychiatric best practices when rendering care to Optum SLCo members. *No utilization management activities were included in the time calculations and descriptions of quality related efforts listed below.
If you are located in Utah, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities:
Improving Health Care Quality Expenses
- Improve Health (40%)
- Directly outreach inpatient attending physicians to consult on specific individuals in real time, impacting the quality of care during treatment and for discharge planning.
- Review of records and each member's history of care to assess if medical and pharmaceutical treatments are appropriately prescribed and delivered to maximize the opportunity for improved health and better outcomes from treatment
- Activities to Prevent Hospital Readmissions (15%)
- Analyze hospital readmissions and identifies patterns of facility/provider practice that may be contributing to these readmissions. This activity may result in 1:1 consultation calls
- Collaborate with members of care advocacy and care coordination teams to problem solve challenges related to lack of access to the Utah State Hospital
- Identifies alternative treatment and service options within the inpatient setting or in a lower level of care with more wrap-around supports
- Improve Patient Safety and Reduce Medical Errors (40%)
- Investigate sentinel events involving SLCo Medicaid members, which requires extensive record and policy review, consultation with Optum's Clinical Team, identifying quality of care concerns which may have contributed to the event and presenting incident and recommendations to the Optum National Sentinel Event Committee
- Reviews outcomes of related QOC audits and provider corrective action plans to improve member safety
- Review possible QOC concerns identified by a member, member representative, Optum provider, Optum staff, courts and SLCo DBHS
- Investigate the concerns, rate the level of impact to the member and present findings and recommendations to the Optum National Peer review Committee. Direct follow-up with the provider and review of provider responses focusing on improving safety of members, their families and program staff
- Provide recommendations for network trainings and messaging to minimize similar incidents with other providers, when appropriate
- Monitor progress by reviewing data gathered related to these incidents to determine if patterns emerge. If so, strategize methods to address problems and to promote effective provider interventions
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:
- Doctor of Medicine or Osteopathy
- Current license to practice as a physician without restrictions in the state of Utah
- Board certified in Psychiatry
- 2+ years of management experience overseeing multidisciplinary teams
- Demonstrated understanding of the clinical application of the principles of engagement, empowerment, rehabilitation and recovery
- Knowledge of post-acute care planning such as home care, discharge planning, case management, and disease management
- Computer and typing proficiency, data analysis and solid organizational skills
Preferred Qualifications:
- 5+ years of experience as a practicing psychiatrist post residency
- 2+ years of managed care experience
- Experience in public sector delivery systems and experience in state specific public sector services
- Experience working with community-based programs and resources designed to aid the State Medicaid population
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
The hourly range for this role is $34.42 to $67.60 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
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.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.