Medical Director Delaware Health Plan Community and State

UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health. The Long Term Care Market Medical Director has accountability for ensuring that Clinical Operations initiatives focus on affordability, clinical excellence, growth and focused improvement are implemented and successfully managed to achieve targets. Responsibility: * This position is responsible for leadership and execution of (LTC site name) medical expense management and clinical quality activities. Collaborates with the market lead Medical Director and CEO, clinical operations staff, and other market staff to implement programs to support and meet market and national clinical operations goals, as well as market, network and sales objectives. * Responsible for oversight of local market Clinical Operations staff. * Liaison to network management for network development related to long term care HCBS services. * Reports to local market CEO plan president or Lead Market Medical Director with accountability to the local market CEO. * Leadership role in local clinical operations initiatives. * Manages external physician relationships, acts as community ambassador, and works with market CEO plan president in developing new business opportunities as required. Affordability: * Responsibilities for MEM activities include: HBCS data sharing, hospital data sharing, physician data sharing, working with HSD and other clinical staff to ensure cost-effectiveness. * Support local market data sharing activities include reviewing completed data analysis and establishing a process for sharing data with hospitals and physicians. * Responsible for implementation of complex case review with clinical staff (care managers) * Completing peer to peer communications as required. * Support UHN initiatives and Health Plan Medical Expense and revenue improvement initiatives as required in order to achieve the affordability objectives of the Health Plan and Clinical Operations. * Responsible for managingmonitoring the results of Care Management Health services interventions to ensure that utilization goals are achieved; collaborating with Care Management health services as necessary to maintain focus on achieving targets. Clinical Excellence: work with lead market medical director on HEDIS data collection process and assist in driving Health Plan accreditation activities. Act as liaison for network development of home and community service providers; potential vendor changes; gather market data; act as an improvement catalyst. Communicate to providers on new focus and measureprocess changes. Support all Clinical Quality initiatives and peer review processes including QOC and QOS issues. Growth: Deliver the clinical value proposition in support of the sales and growth activities of the Health Plan including conducting BrokerClient presentations. Promote positive relations with Statelocal regulatory authorities and Medical Societies. Focused Improvement: The Medical Director is responsible for identifying opportunities through participation in local Medical Expense Committees or Market reviews. Active participation in support of Joint Operating, QM, UMMEM, executive Committees. Provides local feedback on and oversight of the performance of Care Management and UBH as requested by the lead local market medical directors, National Director of Clinical Quality Outcomes, the Patient Safety, and the National Director of Medical Expense Management. * Board certifiedeligible in internal medicine, family practice. * Added qualifications in Geriatrics desirable. * Certification in Hospice and palliative care desirable. * Long Term Care experience (nursing home, post-acute short term SNF care, home and community based services, h