JOB SUMMARY

In support of Optum Care Network’s (OCN) mission, vision, and strategic goals to achieve the quadruple aim by focusing on value based care, the Sr. Network Medical Director provides medical leadership in the adoption of the key principles, tools, technologies, and clinical support services essential to population health in a network setting. Through this work, the Sr. Network Medical Director helps create an environment that encourages physicians, care providers and support personnel to collaborate in building successful practices that produce quality medical care in a cost-effective manner while enhancing patient quality of life. This position works actively on the formation of guidelines, policies, practices, procedures, and recommendations for appropriate clinical and business actions.

The Sr. Network Medical Director leads the Network Engagement Team in collaboration with the VP of Network Management and Engagement team Director(s). This key leadership role works collaboratively with the OCN senior leadership team to design and implement effective practice engagement strategies designed to create meaningful change in the delivery of care across our network. This will include engaging practices in a side-by-side, face-to-face fashion with other members of the OCN’s diverse team of professionals in support of performance improvement activities guided by a variety of performance data and benchmarks. This role and accountabilities pertain to all OCN lines of business including Medicare Advantage, Dual Special Needs Plans, Medicaid, Commercial, and others.

ESSENTIAL DUTIES & RESPONSIBILITIES

Medical Leadership and Network Engagement

• Provides medical leadership for the OCN network, leading the engagement team, engaging OCN departments in optimizing messaging to the network regarding care management, quality, risk adjustment, clinical education, affordability, growth, contracting, utilization management, claims, compliance, marketing, communications, and finance programs.
• Accountable for relationship management, clinical and financial performance throughout the network in order to ensure cost effective delivery of health care and ancillary services that are linked to organizational goals. Leads the structure of network pool meetings and ensures these meetings are productive and meaningful in driving performance aligned with the quadruple aim.
• Participates in and provides leadership at regional, community. and other organizational meetings.
• Reviews and trends provider performance data to identify and strategize opportunities for provider improvement.
• Works with leadership in planning and implementation of innovative clinical care models.
• Drives improvement in HEDIS and CAHPS results; helps design and support the structure and function of quality activities working in partnership with Quality program leadership.

KNOWLEDGE, SKILLS, AND ABILITIES

• Fully embraces the value independent private practices provide to patients and the healthcare delivery system.
• Able to serveas an ambassador for OCN among network providers, including hospital systems, FQHCs, Public hospital districts, large/medium/small multi specialty and single specialty practices, facilities, and ancillary services.
• Able to work collaboratively with a wide variety of health care professionals and staffs, both inside and outside of the organization.
• Knowledge of managed care, including quality, risk adjustment, affordability, utilization management, care management, credentialing, and peer review.

MINIMUM QUALIFICATIONS

Education: Graduate from accredited medical residency program

Experience:

• 5 years’ recent experience in clinical practice
• 5 years’ experience in leadership role in medical facility or related environment
• Significant experience in Medicare Advantage and Population Health approaches

  Certification:

• Current unrestricted Physician (MD/DO) license for the State of Washington
• Board certified in ABMS recognized medical specialty
• Current driver’s license