Community & State LTSS Medical Director – Michigan

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Position in this function is reporting to the CMO of the UnitedHealthcare Community Plan of Michigan, the LTSS Medical Director will serve the Michigan LTSS program as part of the HIDE SNP program as well as support our Medicaid line of business. The medical director provides clinical/geriatric expertise to the care coordination team. The medical director participates in interdisciplinary care teams (ICTs), reviewing individual member care plans and person-centered goals. They provide guidance to the utilization management, care management and quality department staff to support the complex needs and care of older adults. 

If you are located in Michigan, you will have the flexibility to work remotely* as you take on some tough challenges. 

Primary Responsibilities:

• Performs daily review of home and community-based services to approve or deny appropriate services for members.  Will work with nursing staff to clarify requests and documentation as needed
• Represents the health plan in State Fair Hearing cases 
• Appropriate utilization management including managing/monitoring the results of Care Management/ Health services interventions to ensure that utilization goals are achieved, collaborating with Care Management/ health services/behavioral health as necessary to maintain focus on achieving targets
• Participates in healthcare affordability initiatives and meetings at the local market
• Conducts provider telephonic review and discussion, schedules on-site visits and shares tools, information and guidelines related to cost-effective health care delivery and quality of care as necessary
• Participates in the HEDIS data collection process, CAHPS (Consumer Assessment of Healthcare Providers and Systems) improvement, and drives Health Plan accreditation activities
• Supports all clinical quality initiatives and peer review processes
• Provides support for all external audits by state and other regulatory agencies
• Works toward fully integrated clinical model working with Behavioral Health and clinical management
• Collaborates with the Chief Medical Officer, LTSS director, LTSS UM Manager, clinical operations staff, and other market staff to implement programs to support and meet market and national clinical operations goals
• Accountable for providing clinical leadership primarily focusing on home and community-based services review and external communication with network physicians
• Participate in clinical rounds and support care management activities
• Work with other medical director teams focusing on inpatient care management, clinical coverage review, member appeals clinical review, medical claim review and provider appeals clinical review
• Represent UHC externally in healthcare/provider meetings, various association/organization meetings, State, and other constituent meetings/presentations
• Work with CMO in developing innovative health programs/models for improving health outcomes
• Ensure timely medical decisions, including after-hours consultation as needed
• Management of the health plan’s Quality Assessment and Performance Improvement Program (QAPI)
• Manages day-to-day operations and monitors the integration and processing of members to optimize appropriate use of behavioral and physical health services
• Assists CM Managers in assessing members’ need for case management services
• Attends case management meetings and monthly rounds as scheduled
• Collaborates with the integrated case management team, during scheduled meetings and informally as needed
• Support NCQA LTSS certification 
• Collaborate with Care Management, quality, and population health teams and others to drive comprehensive, innovative care solutions for LTSS members
• Reviews individual member care plans and provides suggestions to better meet the member needs
• Provides training to care coordinators, service coordinators and utilization management staff on specific topics related to our older members
• Participates in quality-of-care reviews to make sure care standards are in keeping with best practices for care of older adults and vulnerable individuals
• Helps utilization management, care management and quality department staff understand the complex needs and care of older adults and make person-centered decisions
• Maintains patient well-being and independent functioning
• Partners with other members of the ICTs, including, but not limited to, pharmacy, behavioral health, transition coordination team members and long-term services and supports (LTSS) and Dual Special Needs Program providers

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 Licensed physician in Michigan
• Board Certified in an ABMS or AOBMS specialty 
• 5+ years of clinical practice experience; solid knowledge of managed care industry and the Medicaid line of business
• 2+ years of Quality management experience
• Familiarity with current medical issues and practices 
• Proficiency with Microsoft Office applications Hands-on utilization and/or quality management experience
• Proven solid leadership skills as demonstrated by continuously improved results/team building, and effectiveness in a highly matrixed organization 
• Proven excellent interpersonal communication skills 
• Proven superior presentation skills for both clinical and non-clinical audiences 
• Proven ability to develop relationships with network/community physicians and other providers 
• Proven excellent project management skills 
• Proven solid data analysis and interpretation skills; ability to focus on key metrics 
• Proven solid team player and team building skills 
• Proven strategic thinking with proven ability to communicate a vision and drive results 
• Proven solid negotiation and conflict management skills 
• Proven creative problem-solving skills
• Demonstrated leadership skills
• Proven innovative problem-solving skills
• Proven ability to develop strategies, tactics and partner across organizations

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy 

The salary range for this role is $269,500 to $425,500 annually based on full-time employment. Salary Range is defined as total cash compensation at target. The actual range and pay mix of base and bonus is variable based upon experience and metric achievement. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, 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.    

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.      

UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.