UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm)

*If you are in the New York, NY area, this office-based position (with flexibility to telecommute) is ideal if you are seeking to become part of a fast-moving medical management team. *

Primary Responsibilities:

• Serve as the Physical Health Medical Director to manage the medical needs of members enrolled in the Health and Recovery (HARP) program, Medicaid, Dual Special Needs and Essential Health Plans in New York. A Primary Care or Adult Medical specialty is preferred
• Become part of the Senior Leadership Team to support Health Plan Quality and Affordability programs to doctors, patients and customers; in order to inform care choices and drive improvement
• Provide Medical expertise to the Behavioral health/substance abuse/SMI teams to support medical management by assessing the plans of care to evaluate the risks of psychotropic drugs
• Work with the Senior Leadership Team to support and improve relationships with the Health Plans network of Accountable Care Organizations, Federally Qualified Health Centers, group practices, Health Homes and hospital systems
• Support and develop Quality initiatives to improve quality scores, performance improvement projects and help providers reach their quality goals
• Provide oversight and management of the HEDIS data collection process and other processes that drive Health Plan accreditation activities
• Support the Health Plans Care Management activities (Whole Person Care, Healthy First Steps programs) and participate in various patient care rounds
• Support the teams managing fair hearings, prior authorizations, Utilization Management and appeals and grievance departments
• Focus is on integration of Behavioral and Physical Health for members in the HARP program
• Deliver the clinical value proposition in support of the sales and growth activities of the Health Plan in multiple lines of business in New York
• Interact with State and other regulators to provide data, conduct planning and resolve issues as required to maintain excellent relationships with auditors and regulators
• Identify opportunities to address healthcare disparities, improve costs and quality, as well as ensure compliance with all State regulations. Lead committees and meet with Hospital and State partners as necessary

You’ll interact with internal partners and external providers, vendors, State and Local authorities to support multiple programs in Medicaid and Medicare. Success in this technology-heavy role requires exceptional leadership skills, the knowledge and confidence to make autonomous decisions and an ability to thrive in a production-driven setting.

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:

• MD or DO degree (adult medical specialties)
• Active, unrestricted physician state license in New York, or ability to obtain same
• 5+ years of clinical practice experience post residency
• Solid understanding of and concurrence with evidence-based medicine (EBM), Medicaid and managed care principles as well as Physical/Behavioral Health clinical integration

Preferred Qualifications:

• Board Certification in Adult Medical Specialty
• Hands-on utilization and/or quality management experience
• Project management or active project participation experience
• Substantial experience in using electronic clinical systems
• Familiarity with data analytics in Healthcare

UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.

Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place 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.

Job Keywords: Medical Director, Physical, Behavioral Health, Adult, Physician Executive, Clinician, Clinical Quality, HEDIS, Value Based, Doctor, Appeals, PMPM, Sales, Growth Activities, Work In Office, In Office, New York, NY