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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.
In support of OptumCare Midwest Region's mission, vision, and strategic goal to achieve the quadruple aim by focusing on value-based care, the Network Medical Director provides clinical leadership in guiding network medical practices in the adoption of the key principles, tools, technologies, and clinical support services essential to the population health management in their designated market(s). This opportunity provides direction, coordination, support, and accountability to Primary care practices of various sizes, multispecialty groups, hospitals, and ancillary facilities. The Network Medical Director works collaboratively across a team to help foster contracted PCP group engagement and performance within the core fundamentals of Value Based Care delivery - STAR/HEDIS performance, risk coding and documentation, and affordability. This is an administrative role which works closely with the Client Services Team in driving risk performance, patient engagement, practice engagement with central supports like care management programs, analytic platforms, and wrap around care services.
The Network Medical Director reports to the Chief Medical Office for the OptumCare Midwest Region.
This position requires you to be located within the greater St. Louis area and willing to travel within the state of Missouri with occasional overnight stays. It is a field-based position requiring frequent face-to-face interfacing with local network medical practices throughout the assigned state.
Medical Leadership
- Leads onboarding discussions with new practices joining the network, focusing on setting appropriate and customized performance expectations in collaboration with the practice leaders
- Establishes and messages clear standards and expectations for the professional performance of the provider/provider groups in their designated market(s) of the Midwest Risk Bearing Entity (RBE).
- Collaborates in teaching clinicians and clinical operations teams about Medicare Risk Adjustment, CMS STARs/HEDIS, and overall population health approach to patient care in both formal presentations and off the cuff at impromptu opportunities
- Seeks to align Risk Adjustment, Quality, and Affordability initiatives internally and translate into ways network practices can actively engage in easily using these resources.
- Operates with a tone of service and collaboration, leading their designated market(s)
- Collaboratively work with the clinical and operational staff of the practices to develop strategies and design solutions to improve the value of care, clinical outcomes, affordability, and patient experience
- Works with RBE leaders to support the integration of Quality Improvement programs, Utilization Management reports, and Disease Management programs
- Reviews and trends group/provider performance data to identify and strategize opportunities for improved performance
- Reports out at the Value Based Care Council, Quality Committee, Regional Executive committee, or Provider Meetings as requested.
- Travel within their assigned state(s) on a regular basis as needed with occasional overnight travel.
Required Qualifications:
- M.D, D.O., or M.B.B.S
- Board certification in Family or Internal Medicine
- Active unrestricted license to practice medicine in Missouri
- At least five years of recent clinic-based clinical practice experience after completing residency training
- Current unrestricted driver's license
- Able to travel, with occasional overnight travel
- Experience and knowledge of the local Missouri market
- 2+ years of experience in a physician leadership role in a medical facility or related environment preferred. Well-versed in guiding conversations with clinicians, operations teams, and executive leadership in various organizations.
- Knowledge of managed care, including risk adjustment, affordability, quality (STARs/HEDIS), utilization management, care management
Preferred Qualifications:
- Able to quickly customize the conversation with contracted groups at various stages of population health development.
- Proven track record of working well with Physicians, APRN, Physician Assistants, Coders, Schedulers, Managers, Directors, and Executives to assure care delivery is a patient-centered, timely, effective and evidence-based approach to clinical care across all Primary Care and specialty care participants.
- Advanced knowledge of Medicare Advantage and SNP/D-SNP programs
- Recent clinical practice experience in a Primary Care based setting
- Strong understanding of local market and healthcare landscape