Medical Director - Clinical Policy - Virtual
Tampa , FL
Share
Posted Today
Apply Now Processing...
Email Job
Apply Now Processing...
Email Job
Job Description
Medical Director - Clinical Policy - Virtual
In the rapidly evolving health care landscape, UHG is optimally positioned to lead innovation and develop transformative solutions to Help People Lead Healthier Lives and Help Make the Health System Work for Everyone.
The Medical Director Clinical Policy to support policy development and implementation for individual exchange business, is responsible for leading and executing the strategic vision for UHC Clinical Policy and individual exchange products. The medical director will be responsible for:
* Delivering high value and quality for customers through policies and programs to achieve:
* The Triple Aim - better care, lower cost, better clinical outcomes
* Reduction in unwarranted clinical variation
* Collaboration with key internal and external stakeholders to align goals and strengthen partnerships:
* Internal - including UHG Medical Affairs, External Affairs, Clinical Operations, Clinical Pharmacy, Behavioral Health and Lines of Business
* External - including regulators, governmental agencies, medical societies, health plans, academic research centers and health care technology companies
* Keeping abreast of developments at the intersection of science, technology, analytics and business to champion clinical innovation and policy transformation
* Understanding trends and customer expectations shaping the health care industry
* Lead development and execution of end to end Next Gen clinical policies and care pathways development to drive value creation, including:
* Identifying opportunities and priorities through data and advanced analytics
* 'Whole person care model' including medical, pharmacy and behavioral health components of care
* Evidence-based Utilization Management bundles focused on optimizing clinical outcomes and improving the care experience
* Personalized care and proactive support for members throughout the care journey, from wellness to episodic/chronic condition management and palliative care
* Incorporating new care delivery models, including telehealth and virtual care
* Improving administrative simplification throughout the Utilization Management process
* Analysis and provision of clinical care guidelines:
* Provision of access for our membership to safe and effective healthcare technologies, devices, pharmaceuticals, and services
* Review of the medical literature
* Provision of guidance of benefit and coverage interpretation
* Provision of decision support for internal clinical reviews
* Provision of a consistent, compassionate approach to the creation of policies that are compliant with legal and regulatory requirements
* Lead and execute internal and external communications for new and relevant clinical policy updates
* Lead execution for UHC clinical content development and rules translation
Lead strategic policy development toward digital therapeutics and digital capabilities
Expertise in advancing evidenced based approaches to policy development
Will be a leadership position with opportunity to develop strategic partnerships both internally and externally.
Continue to align on individual state benchmark plans requirements
Requirements:
* MD or DO active unencumbered medical license to practice from at least one state in the US
* Active board certification verifiable through the ABMS/AOA
* At least 5 years of active medical practice experience preferred
Preferred qualifications:
* At least 5 years of health plan administration experience in medical management
* Strong leadership and operational skillset in a matrixed environment
* Excellent written and oral communications skills including interpersonal communication and presentation skills
* Strong knowledge of managed care industry and regulatory requirements
* Strong understanding of advanced analytics
* Strong understanding of medical informatics
* Experience in government relations and health care policy
* Experience engaging with key stakeholders in the health care industry: regulators, governmental agencies, medical societies, academic research centers and health care technology companies
* Clinical/medical policy operation experience
* Medical coding, CPT, ICD10, HCPCS proficiency
* Excellent project management skills
* Creative problem solving skills
* Basic computer skills, typing, word processing, presentation, and spreadsheet application skills and internet researching skills.
Transforming health care and millions of lives starts with the values you embrace and the passion you bring. Find out more and join us. It's an opportunity to do your life's best work.SM
Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can 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.
Read More
Apply Now Processing...
Job Summary
Company
UnitedHealth Group
Start Date
As soon as possible
Employment Term and Type
Regular, Full Time
Work Hours (i.e. shift)
Day Job
Required Experience
5+ years