Community & State Health Arizona Health Plan Medical Director for Special Health Care Needs/DDD - Hybrid role - Phoenix
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The C&S Plan Medical Director for Special Health Care Needs (SHCN) has accountability for ensuring that local health plan, United Clinical Services and UHC initiatives focusing on delivering clinical excellence, quality ratings improvement with the goal to be best in class, appropriate inpatient and outpatient covered-service utilization and support health care affordability. Medical Directors are expected to help drive integrated health system transformation including working with Accountable Care Organizations, Alternative Payment Models, assisting to address provider network engagement and issues, support mandated legal and contractual provisions, compliance, growth strategies and develop/lead focused improvement projects that are implemented and successfully managed to achieve goals. This position reports to the local C&S plan CMO and has dotted line relationships to the Plan CEO, C&S market-assigned Regional Chief Medical Officer and C&S Chief Medical Officer. The C&S Plan Medical Director primary responsibilities are directed towards C&S plan activities as defined by the C&S plan CEO and collaborates with Enterprise Clinical Services (ECS) staff, Optum Behavioral Health staff, and other market and regional matrix partners to implement programs to support and meet market C&S, UHC and line of business goals. This position has direct supervision of one or more employees, including the Adult or Child Healthcare Administrator and close collaboration with peer Medical Directors.
If you are located in Phoenix, AZ, you will have the flexibility to work from home and in the office 2-3 days a week in this hybrid role* as you take on some tough challenges.
Quality + Affordability – The Plan Medical Director has primary responsibility and accountability for medical performance and targets for the local C&S plan(s) being overseen. This will require a close working relationship with the plan CMO, local plan staff, UCS and OBH clinical operations teams as well as with the C&S and UHC national affordability team. Activities may include conducting Joint Operations Committee meetings with prioritized providers and Accountable Care Organizations, in coordination with Network and ECS, contributing to and implementing programmatic and strategic decisions, data sharing with physicians and physician groups on quality and efficiency improvement opportunities, and implementing local Health Care Affordability Initiatives. The Medical director will be engaged as a clinical lead for healthcare affordability initiatives at the local market and establishing a process for sharing data and completing peer to peer communications as required. Additionally, the Plan Medical Director has primary responsibility to help support and oversee new and existing clinical model operations, including Accountable Care relationships, Whole Person Care and affiliated care management programs, regulatory programs such as those defined by the Center for Medicare and Medicaid Services (CMS) like the Model of Care. They will support the CMO for medical dental, pharmaceutical, and or social initiatives and quality programs as required to achieve the appropriate utilization, affordability, HEDIS and Star goals of the C&S Health Plan. Medical Director is accountable for building and leaning into relationships with internal and external partners to meet or exceed market, regional and national requirements. The Plan Medical Director has contributing oversight responsibility of the C&S market peer review process as defined by State regulator as well as participating in or leading the applicable committees such as Provider Advisory Committee (PAC) and Healthcare Quality Utilization Management (HQUM). They will work teams to direct all member care to in-network providers unless care cannot be provided in network and in state. In which case, they will work to complete single case agreement for the highest quality and most cost-effective care with an AHCCCS registered provider or facility.
Clinical Excellence, Quality Standards and Service Performance – The C&S plan Medical Director helps oversee, and contribute to, the HEDIS and STARs process and improvement and performance strategy, CAHPS and NPS improvement strategies and support necessary Health Plan accreditation activities. The plan Medical Director is required to help achieve or exceed all applicable HEDIS, Stars and local state performance targets and goals otherwise specified for the local C&S plan. The Medical Director should act as an improvement catalyst for all service and quality-related efforts, influence, participate and communicate to ACOs and other network providers or vendors on new focus and measure/process changes. The Medical Director supports all Clinical Quality initiatives and peer review processes including Quality of Care and Quality of Service (grievance) issues and is responsible for representing the local C&S plan at State-level Fair Hearings and performing plan-level member/provider grievance and appeals reviews, as necessary. They will also actively participate in or lead Physician Advisory Committees (PAC); Healthcare Quality Utilization Management (HQUM), Quality Management Committee (QMC) and other associated quality and/or member/provider service-focused committees.
Innovation and Focused Improvement — As Medical Director, a culture of innovation and continuous improvement identification is to be incorporated at all levels of work. They are expected to collaborate with peers, Health Services, Quality Management, Behavioral and key health plan staff such as the Adult and Child Healthcare Administrators and UHC network management colleagues in efforts to transform the health system and exceed all regulatory expectations. Local responsibilities include driving/supporting Accountable Care Organization growth and performance improvement, growth, APM deployment, target setting monitoring, as well as ongoing leadership during monthly JOCs. Knowledge of payment reform and value-based contracting variants for C&S will be required. Medical Director is accountable for oversight or support of the various clinical models within the market, such as Whole Person Care, Care Advocacy, Continuum of Care, and complex care multidisciplinary rounds. Secondary responsibilities will include, but are not limited to, other clinical practice transformation efforts, patient-centered medical and behavioral health homes, innovative vendor and provider-led care coordination programs, health disparity assessments and action planning, high-performance network development and consumer engagement.
Growth, Equity, Inclusion and Diversity – The Medical Director will help deliver our clinical value proposition focused on quality, affordability, and service, in support of growth activities of the C&S Health Plan, consistent with our prevailing values and culture. The plan Medical Director reviews and edits policies, SOPs, communications materials as required and represents the voice of the market-based customer in program design. Medical Director contributes to any RFP/re-procurement activity in the state, as requested, delivering subject matter expertise and clinical perspectives. The Plan Medical Director actively promotes positive relations with State/local regulatory authorities and Medical Societies, where possible, will participate with partner organizations, health equity and disparity efforts such as the DE&I counsel, promote cultural competencies and other factors which holistically help the health plan better meet community and member needs.
Relationship Equity and State Compliance—The Plan Medical Director maintains a solid working knowledge of all government mandates and provisions for the local C&S market, as well as working across the enterprise to implement and maintain compliant clinical programs and procedures. They participate as a SME in reviewing work plans and in operational reviews and audits. They also are committed to being effectively and positively engaged with our external constituents such as consumers/members, physicians, medical and specialty societies, hospitals and hospital associations, federal/state regulators, and market-based collaborative. The Medical Director will work collaboratively in these activities with ongoing ECS and C&S initiatives under the direction of the Plan CMO, C&S Medical Director/CMO and/or the C&S Regional CMO. The Plan Medical Director will be called upon to support outward facing relationships to State regulators based upon Contract, and direction of Plan CMO, Plan President and C&S CMO and should provide clinical thought leadership with external entities and the state. All public speaking and media documents must be approved via appropriate UHC protocols. All outside committee, teaching, board, or non-profit board participation must be approved via appropriate UHC protocols.
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.
Skills, Experiences, Qualifications:
- Ability to support and contribute to a team that values organizational and Plan success over personal success; provide ongoing coaching and feedback with colleagues and other team members to ensure peak performance; identify and invest in high potentials; actively manage underperformance
- Focus staff on the company's mission and values; inspire superior performance; ensure understanding of strategic context; set clear performance goals; focus energy on serving the customer; provide ongoing communication to the team; discontinue non-critical efforts
- Demonstrate pro-active, solution-oriented approaches to work efforts and drive disciplined, fact-based decisions
- Execute with discipline and urgency: Drive exceptional performance; deliver value to the customer; closely monitor execution; drive operational excellence; get directly involved when needed; actively manage financial performance; balance speed with analysis; ensure accountability for results
- Medical Directors are a leadership position within the health plan, key contributors to the “C” Suite level team, a skilled General Manager with a clinical expertise
- Drive change and innovation though continually seeking and implementing novel solutions; create a culture that thrives on continuous change; inspire people to stretch beyond their comfort zone; take well-reasoned risk; challenge "the way it has always been done"; change direction as required Model and demand integrity and compliance with all company policies, and local, State, and federal regulations
- Proven ability to execute and drive improvements against stated goals
- Ability to develop relationships with network and community physicians and other providers
- Visibility and involvement in the medical community
- Ability to successfully function in a matrix organization exhibiting the culture of United Health Group
- Deliver value to members by optimizing the member experience and maximizing member growth and retention
- Lead and influence Health Plan employees by fostering teamwork and collaboration, driving employee engagement, and leveraging diversity and inclusion
- Develop and mentor others while also building awareness to your own strengths and development needs
- Influence and negotiate effectively to arrive at win-win solutions
- Communicate and present effectively, listen actively and attentively to others, and convey genuine interest
- Lead change and innovation by demonstrating emotional resilience, managing change by proactively communicating the case for change and promoting a culture that thrives on change
- Play an active role in implementing innovation solutions by challenging the status quo and encouraging others to do so
- Drive sound and disciplined decisions that drive action while effectively using financial knowledge and data to manage the business
- Drive high-quality execution and operational excellence by communicating clear directions and expectations
- Manage execution by delegating work to maximize productivity, exceed goals and improve performance
Arizona C&S Qualifications:
- Working knowledge of the Arizona Health Care Cost Containment System (AHCCCS), Department of Economic Security (DES), Arizona department of Health Services (ADHS) and other related state agencies
- Experience and/or direct working knowledge of the AHCCCS health plan types (Complete Care; DD; LTC)
- Understanding of dual Special Needs health plans (DSNP) and Medicare/Medicaid integration and coordination of benefits with DSNP or other third-party payers
- Clinical, professional knowledge and interest in special heath care needs (SHCN) populations and fully integrated healthcare models
- Ability to develop solid, trusted relationship with Division of Developmental Disability and immediate availability for regulator concerns
- A willingness to travel locally, in Arizona, to communities where clinical partnerships require face to face interactions
General and SHCN Qualifications:
- Active/unrestricted Arizona Licensed physician
- Board Certified in an ABMS or AOBMS specialty
- 5+ years of clinical practice experience
- 2+ years of Quality management experience
- Solid knowledge of managed care industry and the Medicaid line of business including Division of Developmental Disability (DDD) Long Term Care (DD LTC) and members requiring Children Rehabilitative Services (CRS)
- Familiarity with current integrated medical and behavioral health issues and practices
- Solid leadership skills, as demonstrated by continuously improved results, team building, and effectiveness in a highly matrixed and integrated organization
- Excellent interpersonal communication skills
- Superior presentation skills for both clinical and non-clinical audiences
- Proven ability to develop relationships with network and community physicians and other providers
- Excellent project management skills
- Solid data analysis and interpretation skills
- Ability to focus on key metrics pertinent to enterprise and Arizona Community Plan goals
- Solid team player and team building skills
- Strategic thinking with proven ability to communicate a vision and drive results
- Solid negotiation and conflict management skills
- Creative problem-solving skills
- Innovative thinking and ability to develop innovations with an eye for impact of emerging technology on enterprise and on AHCCCS Arizona Complete Care (ACC) and Division of Developmental Disability (DDD) Developmental Disability Long Term Care (DD LTC) members
- Proficiency with Microsoft Office applications (Word, Excel, PowerPoint)
- Provide education to all integrated and supportive teams (Optum Behavioral Health, Clinical Services) regarding contractual and regulatory requirements for members with SHCN, including but not limited to DD LTC and CRS
- Maintain relationship with all leadership Multi Specialty Interdisciplinary Clinics in the state of Arizona
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.
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.