National Medical Director of Radiology and Imaging Programs - UHC

National Medical Director Of Radiology And Imaging Programs

At United Healthcare, 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 optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

The National Medical Director of Radiology and Imaging Programs is responsible for leading the strategy, design, development, and oversight of payer-led radiology and imaging programs across United Healthcare. This role will guide the modernization of radiology health plan medical management programs, including utilization management, prior authorization, post-service clinical review, clinical decision support, and evidence-based care pathways, with the goal of improving affordability, quality, provider experience, and member outcomes.

This position will be reasonable for integrating UHC's largest PA programs for Radiology and Cardiology which currently provides $425M or 19% of the direct medical expense savings. The position will also support UM modernization including increasing automation and reducing denials, and developing bundled authorizations, further contributing to reducing operating expenses and simplifying the prior authorization process.

You'll enjoy the flexibility to work remotely
* from anywhere within the U.S. as you take on some tough challenges.

For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.

• Clinical Strategy Leadership in Program Design and Development
  • Possess solid clinical and operational knowledge having worked in the designated medical specialty of Radiology and Imaging
  • Oversee the strategy for health plan Radiology and Imaging specialty programs using knowledge and understanding of the healthcare industry, emerging technology and trends, and current medical specialty guidelines and peer-reviewed literature, incorporating feedback from key stakeholders
  • Lead the design of clinical program development for modernizing utilization management and retrospective clinical review programs across the continuum of Radiology and Imaging procedures to improve health outcomes with a focus on member and provider experience
  • Provide leadership and clinical insights for Radiology and Imaging category activities across the enterprise such as value-based care programs, quality improvement initiatives, and care management
• Process Optimization
  • Identify pain points in current prior authorization processes and propose innovative solutions
  • Support effective implementation in partnership with teams in clinical operations and technology
  • Participate in the development of pilot programs and evaluate performance metrics for automation initiatives
  • Build and develop relationships across teams to ensure effective feedback loops and that deliverables are met
  • Set and review program metrics for continuous enhancements, updates, and improvement
• Data and Technology Proficiency
  • Assess and interpret complex financial and clinical data to evaluate feasibility of proposed initiatives
  • Direct the healthcare analytics team as they work through hypothesis and problems and synthesize the results and to assure model assumptions are accurate
  • Evaluate clinical, quality and claims data to identify opportunities for improvement of clinical programs
  • Provide clinical insights and input to guide technology partners in development of large language learning models and technical capabilities for care pathways and bundled authorizations
• Communication, Collaboration and Relationship Building
  • Articulate and represent UHC clinical strategy to executive leaders across the enterprise and to external stakeholders and be able to speak clearly on complex problems
  • Advocate with leadership across the organization to create better alignment with business segments, network, and functional areas, thereby ensuring internal and external coordination and a unified approach to the market and…