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Job Details

UnitedHealth Group

Senior Medical Director - Albuquerque, NM


Medical Director



Albuquerque, New Mexico, United States

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm)

The Senior Medical Director will lead the market’s affiliate provider network strategy, execution, and optimization. The leader will be accountable for developing, supporting, and growing OptumCare’s network of independent practice affiliate clinicians that will deliver value-based care for our risk population. This individual will lead a team with accountability for affiliate provider network contracting, affiliate provider performance improvement (including Medicare Risk Adjustment Factor and HEDIS/STARS education), and program quality assurance/improvement. This individual will work to build strong, trusted relationships with other clinicians to influence and change behavior in a collaborative way. The Senior Medical Director will be required to work cross-functionally and will be expected to provide insight and perspective from the network point of view to the CMO and other members of the market leadership team. This leader will support the CMO’s work in utilization management (UM), prior authorization, and oversight and direction of inpatient and skilled nursing facility utilization. Frequent travel within the metropolitan area is expected.

Leadership Competencies:

  • Business Acumen: Uses economic, financial, market, and industry data to understand and improve business results; uses one’s understanding of major business functions, industry trends, and own organization’s position to contribute to effective business strategies and tactics.
  • Leadership: Demonstrates the traits, inclinations, and dispositions that characterize successful leaders; exhibits behavior styles that meet the demands of the leader role. Identifies goals for site or department in consultation with other clinical and operations leaders; leads efforts by providers and teammates to achieve those goals
  • Building Trust: Interacts with others in a way that gives them confidence in one’s intentions and those of the organization.
  • Facilitating Change: Encourages others to seek opportunities for different and innovative approaches to addressing problems and opportunities; facilitates the implementation and acceptance of change within the workplace. Encourages others to participate in creating a positive culture of the care delivery organization and to uphold the Mission, Vision and live the Core Values.
  • Managing Conflict: Deals effectively with others in an antagonistic situation; uses appropriate interpersonal styles and methods to reduce tension or conflict between two or more people.
  • Building Strategic Work Relationships: Develops and uses collaborative relationships to facilitate the accomplishment of work goals.

Primary Responsibilities:

  • Strategic leadership over the OptumCare affiliate provider network program in New Mexico
  • Working on best practices, policies, telehealth and novel approaches for risk adjustment programs
  • Apply understanding of patient care quality metrics to enhance clinical outcomes (e.g., HEDIS; 5 STAR; disease-based metrics) in order to drive/achieve quality outcomes for Optum NM’s Affiliate Program
  • Lead efforts for RAF/HEDIS/STARS education to improve metrics and outcomes for the Affiliate Program
  • Effectively engaging and bringing understanding to our external constituents such as physicians, medical and specialty societies, hospitals and hospital associations, and state regulators
  • Identifying affordability opportunities through participation in local medical expense committees or market reviews
  • Provide assistance in appeals review where appropriate
  • Supporting all clinical quality initiatives and peer review processes

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:

  • Fully licensed as a physician in the state of New Mexico
  • Two (2) years’ experience at senior leadership level in medical group or network
  • Five (5) years’ experience as a practicing physician, preferably in a medical group
  • Current MD/DO unrestricted medical license in the state New Mexico or in the process of obtaining certification unless granted an exemption by Credentialing Committee
  • New Mexico Pharmacy/DEA Registration if applicable to practice

Preferred Qualifications:

  • Master’s Degree in related filed
  • Experience in both fee-for-service and managed care operations
  • Experience and knowledge of Medicare Advantage programs (STARS, RAF, HEDIS, CHAPS/HOS etc)
  • Experience with identifying Medicare risk adjustment and presenting findings to client/clinicians

Knowledge, Skills, & Abilities:

  • Thorough understanding of medical group business models and clinical processes
  • Ability to strategically lead regionally to ensure accurate diagnostic codes in order to maximize risk adjustment (RAF)
  • Experience with identifying Medicare risk adjustment and presenting findings to client/clinicians; Working knowledge of managed care and value based medicine
  • Excellent understanding of medical group financial concepts, including revenue cycle, physician compensation models, and preferably including managed care financial concepts (capitation, IBNR, MLR)
  • Helping set agendas/strategies and leading multifaceted teams of Physician Business Managers, Risk Adjustment dyads, and Quality partners
  • Developing and cascading clinical outcome/improvement messaging to business units to foster tighter working culture
  • Excellent communication skills, both verbal and written
  • Ability to comfortably use Microsoft Word, Excel, and PowerPoint

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity 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.