Senior Medical Director Texas, UnitedHealthcare Retiree Solutions

UHG Corpus Christi, TX

About the Job

Senior Medical Director Texas, UnitedHealthcare Retiree Solutions

UnitedHealthcare is part of the family of companies that comprises UnitedHealth Group, the national leader across most major segments of the US health care system.

When you use your skills, talent and energy for the members of UnitedHealthcare, you'll be able to do more and do it better. If you're ready to help make health care work better for more people, you can make a historic impact on the future of health care in the Medicare and Retirement population that we serve. We contract with states and other government agencies to provide care for these individuals. Working with physicians and other care providers, we ensure that our members obtain the care they need with a coordinated approach.

By tapping into our extensive knowledge base to manage care plans for retirees, elderly, disabled, and chronically ill people, you'll ensure that their unique needs are fully understood by all care givers. In short, you'll help make a huge health care system work like a personalized health care team.

This enables us to break down barriers, which makes health care easier for our customers to manage. That takes a lot of time. It takes a lot of good ideas. Most of all - it takes an entire team of talent. This team is comprised of individuals with the tenacity and the dedication to make things work better for millions of people all over our country.

Description of role:
The Senior Medical Director, UnitedHealthcare Retiree Solutions is a physician leader who will report directly to the Chief Medical Officer, Retiree Solutions. This is a Texas-based position. This physician will execute and support the strategic plan for Retiree Solutions and other stakeholders in the Medicare Advantage marketplace. Responsibilities include, but not limited to, account level analysis with development and deployment of solutions that address affordability, retain membership and improve quality outcomes. The medical director oversees all aspects of account specific clinical management related to quality, access, affordability. She/he works closely with sales, strategic account executives, and market leaders for local initiatives, quality, population health and care management, and medical utilization programs. She/he manages the clinical relationships with key accounts, healthcare professionals, business partners and industry thought leaders. This role will be integral in client, member, and provider engagement as well as business development. The medical director represents the business in a variety of internal and external settings.

Specific Responsibilities:
• Ability to work closely with sales, marketing, account management, healthcare economics and market business and clinical leaders, to respond to written proposals as well as present at finalist and renewal oral presentations that grow and maintain membership and long-term relationships
• While providing that support, is facile with face-to-face or remote remediation discussions
• Uses a data driven and experiential consultative approach with clients on analytics, assessment and potential solutions
• Assists in the oversight, management and coordination of activities of UnitedHealthcare Medicare & Retirement, Employer & Individual with United Clinical Services, Quality Management Performance, Member Experience, OptumHealth, Optum Behavioral Health, other internal business partners and external vendors
• Serves as an external expert spokesperson to communicate our clinical value story to audiences including public sector, labor & trust, national accounts, professional associations and other thought leadership events
• Provides strategic input to quality, clinical programs, affordability and fraud and abuse teams
• Develops deep knowledge of UHG resources and capabilities, including but not limited to HouseCalls and Optum solutions
• Demonstrates expertise in CMS regulations, including the Star Ratings and Risk Adjustment
• Ensures all aspects of clinical strategy at the account/plan level are executed and provides oversight and direction for the implementation of clinical programs and strategies
• Maintains expertise in adult medicine, geriatrics, end-of-life care, regulatory guidelines and Medicare payment policy
• Represents the CMO, Retiree Solutions as needed in national level committees and meetings setting medical necessity strategies
• Serves as a subject matter expert in the development of business cases, ROI calculations for account specific clinical initiatives, clinical guidance to business leaders regarding appropriate utilization, improving outcomes while decreasing cost
• Supports Star Ratings/HEDIS/CAHPS/HOS performance, accreditation and compliance programs
• Participates in the development and execution of clinically integrated networks
• Provides consultative advice to local network management regarding the medical delivery system, enhancement to services, provider patient care issues
• Makes recommendations on solutions to leadership; resolution management
• Manages tasks successfully and is self-directed


• Unrestricted licensed physician in Texas – required
• Must reside in Texas - required
• Board Certified in ABMS primary care specialty - required
• Fellowship training and certification in Geriatrics or Hospice/Palliative Medicine – Strongly preferred
• 5+ years clinical practice and/or risk-based Medicare care models
• 5+ years in previous leadership positions
• Managed care experience, preferably Medicare Advantage
• Prior health plan sales experience
• Excellent presentation skills for both clinical and non-clinical audiences
• Data analysis and interpretation skills
• Extensive record of performance, by meeting and exceeding operational goals in health care quality and cost management
• Ability to develop lasting relationships with business partners, network and community physicians and other providers
• Strong sense of personal and professional responsibility
• Flexibility and positive attitude essential
• Experience in population health management
• Excellent telephonic communication skills; excellent interpersonal communication skills
• Creative problem solving skills
• Team player and team building skills
• Proven success in change management and innovation
• Proficiency in working in a matrix environment
• Familiarity with current medical issues and practices
• Visibility and involvement in medical community
• Matrixed supervisory skills including clinical mentoring and coaching skills
• Familiarity with current medical issues and practices
• Exemplifies Our United Culture

Careers at UnitedHealthcare Employer & Individual. We all want to make a difference with the work we do. Sometimes we're presented with an opportunity to make a difference on a scale we couldn't imagine. Here, you get that opportunity every day. As a member of one of our elite teams, you'll provide the ideas and solutions that help nearly 25 million customers live healthier lives. You'll help write the next chapter in the history of health care. And you'll find a wealth of open doors and career paths that will take you as far as you want to go. Go further. This is your life's best work.SM

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.