Optum Serve Medical Director - VA Community Care Network - Remote

Position: Optum Serve Medical Director - VA Community Care Network - Remote in US
Job d:

Location:

Eden Prairie, Minnesota, United States Salary: $248,500 - $373,000/year

Job Area:
Medical & Clinical Operations Company:
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Optum Serve is part of the family of companies that make United Health Group, one of the leaders across the US healthcare system.  Optum Community Care Services (CCS) sits within Optum Serve supporting federal contracts such as the Veterans Administration Community Care Network (VA CCN) which provides a network of community care providers to serve Veterans.

The Optum Community Care Services (CCS) Medical Director works diligently to oversee clinical quality provided from community care providers to Veterans. The medical director will work collaboratively with the Patient Safety Specialists in reviewing medical records and determining applicable standards of care. The medical director will Chair the Med/Surg Peer Review Committee and oversee that the Peer Review Committee meets all applicable regulations and legal requirements.

The medical director will facilitate and/or attend other committees including the Clinical Quality Improvement Program Committee.

The Medical Director will be accountable for ensuring that initiatives focused on clinical excellence and CCS clinical quality program requirements are implemented and successfully managed to achieve performance expectations and meet all contractual requirements. The medial director will perform clinical quality reviews of medical/surgical care, program integrity reviews involving regulatory compliance, health care delivery, and other functions to ensure that the best quality of care is provided to Veterans who are community care beneficiaries.  

This position requires working collaboratively and closely with internal and external partners. The medical director is expected to always communicate effectively and professionally with internal and external partners including the clients. Utilization management on such tasks as concurrent review and prior authorization review may be required in future contracts.

This position reports to the Chief Medical Officer, Community Care Services.

The Medical Director also provides leadership to clinical staff through case consultation and case reviews and regularly updates the Chief Medical Officer, CCS. The Medical Director will provide to the Chief Medical Officer, CCS recommendations for clinical quality program process improvements. The Medical Director is accountable for managing resource allocation as is applicable to medical management practices under his or her scope of responsibility.  

The Medical Director will consult with Optum Serve Technology and Consulting Solutions as needed on CMS and other Federal health Market consulting RFIs, RFPs, and contracts for VA Community Care Network and will support the Chief Medical Officer, CCS on various committees as necessary.  You'll enjoy the flexibility to work remotely
* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

Clinical leadership within Optum Serve and reports to the Chief Medical Officer, Community Care Services.  They collaborate with the CEO, Community Care Services which has responsibility for VA CCNDevelops, coordinates, and participates in clinical quality program design, development, implementation, oversight, and monitoring as a medical leader within the Optum Serve team Works collaboratively with the Chief Medical Director, CCS and the CCS leadership team in the development and Implementation of clinical quality management and cost initiatives (Value Based Care) and medical management program development

Works with the Clinical Quality team with patient safety managers, patient safety specialists, the dental director, the behavioral health director, and other internal partners to ensure adherence to clinical quality performance standards

For future contracts, the Medical Director may support whole person care (M/S and BH case and disease management) utilization management and program integrity

Provides for and recommends clinical program enhancements and quality improvements that adhere to the VACCN requirements and reflect emerging clinical solutions and best…