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Medical Director - Richardson TX - (US-TX-Richardson - 75085)
Minimum Education: None
Jobcode: 60144423
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Click Here to Apply OnlineUnitedHealth 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.
UnitedHealth Military & Veterans Services is part of the family of companies that make UnitedHealth Group one of the leaders across the US health care system.
We serve those who serve our nation, providing quality health care services to millions of military beneficiaries across the South.
Our commitment to helping people live healthier lives, and to continue the honor, satisfaction, and quality of the TRICARE military health benefit program is greater than ever. Our efforts complement the Military Health System to demonstrate the best blend of public and private health care solutions.
It's not just business as usual. It is one of our proudest endeavors.
The Medical Director works actively to implement and administer medical policies, disease and medical case management programs, utilization management programs, integrate physician services, quality assurance, appeals and grievances, and regulatory compliance programs with medical service and delivery systems to ensure the best possible quality health care for TRICARE beneficiaries. Accountability for ensuring that initiatives focus on affordability, clinical excellence, TRICARE medical management program requirements and are implemented and successfully managed to achieve performance expectations. This position requires working closely with utilization management on such tasks as concurrent review and prior authorization review. The MD advises leadership on improvement opportunities regarding medical expense programs and clinical programs (CM, DM) that impact medical expense. The Medical Director for UMVS also provides leadership to clinical staff through case consultation and case review. Provides feedback on clinical performance to senior leaders with plans for clinical performance improvement. The impact of work is at the operational level for TRICARE. The Medical Director is accountable to manage resource allocation as is applicable to medical management practices under his or her scope of responsibility.
SUMMARY OF JOB RESPONSIBLITIES:
The Medical Director is responsible for clinical leadership within TRICARE and reports to the Chief Medical Officer and VP Medical Management Services.
OUTLINE OF ESSENTIAL JOB RESPONSIBILITIES/FUNCTIONS TO INCLUDE BUT NOT LIMITED TO:
1. Develops, coordinates and participates in medical management program design, development, implementation, oversight and monitoring as a medical leader within UMVS/TRICARE team:
- Establishes and oversees standards of practice for TRICARE. Assures adherence to UHG and MHS/DoD clinical practice guidelines.
- Working collaboratively with the Medical management senior leader in the development and implementation of medical expense management initiatives and medical management program development.
- Oversees evaluation and management of medical practices within the requirements of a Multi-Function Peer Review Organization.
- Works with the VP, Medical Management Services to ensure adherence to medical management performance standards including quality, utilization and program integrity.
- Assigns, directs, and reviews the work of other medical staff, as assigned.
- Plans and facilitates training and development of clinical staff to improve performance.
- Provides for and recommends clinical program enhancements and quality improvements that adhere to the TRICARE requirements and reflect emerging clinical solutions and best evidences based practices.
- Supports, communicates and facilitates TRICARE wide clinical programs and policies.
- Provides clinical education to clinical staff to ensure TRICARE medical management program success
- Analyzes population-based reports to refine management activities, investigate and define variation, and ensure conformance to expected standards and targets.
- Accountabilities include oversight of medical & clinical processes with a focus on implementing plans of care that meet accepted guidelines and protocols and ensure that optimal and appropriate medical & clinical services are provided.
- Ensures compliance with policies, procedures, bylaws, regulatory requirements, and best practice guidelines.
- Participates in the production of setting performance standards for clinical staff that aligns with program standards and the TRICARE contract. Monitors, assesses, reviews and evaluates clinical employee performance based on the established standards.
- Works with the VP Medic
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