Medical Director for Clinical Risk & Value - Remote

New Yesterday

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.
This opportunity is an important clinical leadership position reporting to the National Medical Director/CMO. The Medical Director for Clinical Risk Value is responsible for diverse functions with a primary scope related to creation of clinical guidelines, workflows, and leading clinical risk adjustment program enablement within the organization. This role represents Optum's Risk Value Ops Department.
Primary Responsibilities:
Clinical Guidelines & Evidence-Based Practice
Lead the development, prioritization, and annual review of clinical guidelines and workflows to support clinical risk adjustment related program development and deployment
Deliver high-value, best-in-class clinical guidelines that serve as the foundation for multiple clinical programs
Analyze medical and clinical evidence; critically assess scientific research and real-world outcomes to develop objective and unbiased guidelines
Demonstrate solid skills in synthesizing and integrating information from multiple sources
Apply a deep understanding of research study design and the quality of clinical evidence
Provide subject matter expertise and guidance to the Clinical Guideline Review Participate in clinical decision-making on guidelines and programs with subject matter experts and stakeholders
Committee and other stakeholders on guideline creation, evidence evaluation, and research
Focus on increased transparency and administrative simplification in guideline development
Monitor regulatory changes and healthcare trends to ensure guidelines remain compliant and innovative
Remain up-to-date on developments at the intersection of science, technology, analytics, and business to drive clinical innovation and guideline transformation
Workflow & Operational Enablement
Develop and implement clinical workflows based on clinical guidelines
Ensure workflows are efficient, scalable, and aligned with organizational goals
Continuously monitor and refine workflows based on performance and feedback
Develop and implement operational enablement, including supporting technology (e.g., EMR), vendor management, procurement, billing, and incentives
Collaborate with IT and operations to enable workflows through technology and process improvements
Coordinate organizational procedures to optimize efficiency and productivity
Cross-Functional Collaboration & Strategic Alignment
Collaborate across national, regional, and local teams to align goals, strengthen partnerships, and build effective feedback processes
Establish business relationships to ensure deliverables are met and priorities are aligned
Provide support in socializing guidelines and implementing programs
Clinical Impact, Risk Adjustment & Innovation
Provide clinical expertise and guidance on risk adjustment initiatives
Monitor and evaluate the effectiveness of guidelines in improving risk adjustment accuracy and clinical outcomes
Analyze the clinical impact of programs on patient care and outcomes
Identify priorities through data and advanced analytics research
Support the creation and review of clinical education and training materials based on new or revised guidelines
Provide training and support to clinical staff on new workflows and guideline implementation
Lead the Creation and Dissemination of Evidence-Vased Medicine (EBM) Educational Content
Keep up to date on medical literature
Lead the development of summaries of current medical literature
Support educational events
Developing modern training and dissemination vehicles such as webinars, e-learning modules, and interactive case studies
Serve as a subject matter expert in evidence evaluation, research methodology, and clinical decision-making
Leverage technology to advance the creation, dissemination, and effectiveness of evidence-based medicine educational content
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:
Active/unrestricted Medical Degree and License in primary specialty
Board certification
5+ years clinical experience providing patient care
2+ years Medicare Advantage risk adjustment and clinical guideline experience
Experience in motivating and influencing others at all levels within the organization
Thorough understanding of evidence-based medicine, with extensive experience in critical review of the medical literature and/or medical research publications
Proficiency working in a matrix environment, with demonstrated ability in systems thinking and enterprise insight to solve complex business problems
Demonstrated ability to think strategically, with proven ability to drive results
Proven solid critical thinking and analytic skills
Proven skills in communicating effectively and efficiently (both verbal and written)
Proven leadership during organizational change to drive transformation effectively in a fast-paced environment, while being adaptable and assisting individuals through the transition
Demonstrated growth mindset in being open and able to break through barriers, while having an ability to leverage innovation
Proven extensive record of performance, by meeting and exceeding established goals
Proven solid data analytic skills
Demonstrated ability to make strategic, operational, and administrative decisions in response to emerging conditions and environmental circumstances
Proven ability to provide recommendations and insight regarding improvements to internal and external processes
Proven ability to manage multiple competing priorities
Compensation for this specialty generally ranges from $269,500 - $425,500 Total cash compensation includes base pay and bonus and is based on several factors including but not limited to local labor markets, education, work experience and may increase over time based on productivity and performance in the role. We comply with all minimum wage laws as applicable. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives.
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.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
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Location:
Eden Prairie, MN, United States
Category:
Management Occupations

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