Administrative -

Primary Responsibilities:

Clinical leadership within Optum Serve and reports to the Chief Medical Officer Community Care Services. They collaborate with the CEO Community Care Services which has responsibility for VA CCN
Develops coordinates and participates in clinical quality program design development implementation oversight and monitoring as a medical leader within the Optum Serve team
Works collaboratively with the Chief Medical Director CCS and the CCS leadership team in the development and Implementation of clinical quality management and cost initiatives (Value Based Care) and medical management program development
Works with the Clinical Quality team with patient safety managers patient safety specialists the dental director the behavioral health director and other internal partners to ensure adherence to clinical quality performance standards
For future contracts the Medical Director may support whole person care (M/S and BH case and disease management) utilization management and program integrity
Provides for and recommends clinical program enhancements and quality improvements that adhere to the VACCN requirements and reflect emerging clinical solutions and best evidence-based practices
Provides clinical education to clinical staff to ensure VACCN clinical quality program success
Accountabilities include oversight of VACCN clinical processes with a focus on Implementing plans of care that meet accepted guidelines and protocols and ensure that optimal and appropriate clinical services are provided
Ensures compliance with all policies procedures bylaws regulatory requirements and best practice guidelines
Participates in the continued implementation and any process improvements of the VACCN clinical quality program
Oversees evaluation and management of medical practices within the requirements of Med/Surg Peer Review Committee
Recruits and maintains participation of external actively practicing providers and manages the Independent Review Organizations (IRO) for specialty review when required
Ensures consistent and continual monitoring of quality of care delivered
Provides recommendations on measures as established within VACCN and other quality metrics such as Hospital Compare HAC and AHRQ set by the VA and Optum Serve
Reviews completed charts on a regular and timely basis in preparation for Peer Review Committee activities
Provides and receives consistent feedback on the clinical quality of care being delivered
Assists where applicable on RFI RFP contracts at Optum Serve Consulting and assisting with future growth opportunities
Other duties as assigned to support Clinical Quality CCS and the enterprise

Youll 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:

MD or DO with an active unrestricted license
Current board certification in Internal Medicine or Family Medicine Surgery Physiatry or Emergency Medicine
5 years clinical practice experience
Demonstrated familiarity with current medical issues and practices
Proficient understanding of Evidence Based Medicine and the application with care and decision making
Proven ability to develop relationships with network and community providers and VA providers
Demonstrated superb communications skills
Demonstrated excellent time management skills
Proven data analysis and interpretation skills
Proven ability to focus on key metrics
Demonstrated creative problem-solving skills
Demonstrated ability to focus on priorities
Demonstrated ability to timely and accurately complete time entries within Costpoint and Global Self Service per company policy
Demonstrated ability to comply with all UHG and Optum employee policies
Ability to travel less than 10%

Preferred Qualifications:

5 years of experience in clinical quality
Experience with Veterans and/or Military medical management