AmeriChoice ICCT Medical Director - Great Opportunity in Pennsylvania!-333045
Description
AmeriChoice ICCT Medical Director - Michigan
AmeriChoice is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.
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 at AmeriChoice.
We contract with states and other government agencies to provide care for over two million individuals. Working with physicians and other care providers, we ensure that our members obtain the care they need with a coordinated approach.
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. Individuals with the tenacity and the dedication to make things work better for millions of people all over our country.
ICCT Medical Director Responsibilities
- Review census daily to proactively identify members with potential observation payment diagnoses, members at high risk for readmission, members who have long stays in a hospital or a SNF;
- Document timely inpatient and SNF UM decision-making with clear rationale for approvals and denials (daily for per diem or % of charges hospitals; initially for DRG, and, again, after 10 days; initially, and, a minimum of twice weekly for SNF and acute rehab)
- Document timely peer to peer discussion with attending (or attempts - if unable to reach) when requested by hospital staff of ICCT due to their disagreement with UM decision; Document rationale for decision to maintain denial or overturn previous decision;
- Mentor staff such that information required to make an informed UM decision are obtained by the ICCT the first time to reduce re-work for hospital staff, attendings, and the ICCT (i.e., learn from cases where the UM denial is overturned after new information is received.)
- Proactively identify members on admission that are high risk for readmission
- Partner with staff to initiate discharge planning upon admission for high risk
- Engage attending, as needed, to support appropriate use of under-utilized hospital-based specialists (e.g., psychiatrist, chemical dependency, palliative care, etc.) and influence the obtainment of orders for transitional care services (e.g., home care, DME, SNF, etc.)
- As needed, support information flow and prioritization across settings for high risk members through peer to peer discussions with PCPs and/or relevant specialists when important to reduce readmissions
- Engage in peer to peer discussions with "carve out" behavioral health providers to ensure coordination of mental health, physical health, substance abuse and chronic pain care
- Reach out to attendings and/or PCP when member at risk for long hospital stay and initiate discussions related to member's previous advance directives, ability of member to make informed decisions, need to petition for expedited guardianship, prognosis assessment, realistic prognosis discussion with member (and/or family), end of life care wishes member and/or family discussion, futile care, ethics committee consultation, palliative care consult, hospice consult, alternative level of care, etc.; Monitor such members closely and touch base with peer to peer with attending at a minimum of weekly for members hospitalized for 10 days or longer including discharge planning to reduce the risk of readmission of innately high risk population
- Partner closely with nursing lead of ICCT to continually reassess structure, processes and outcomes of ICCT for opportunities for improvement and strategies to actualize that improvement
- Monitor results, documentation, and, ICCT staff and management satisfaction with other medical directors supporting ICCT.
- Review and analyze daily, weekly, monthly, quarterly reports for understanding, process improvement, personnel feedback and strategy/prioritization changes.
- Work closely with regional team and other central region (or other region) ICCTs to ensure that best practices are shared across teams (and utilized, when relevant.)
- Coordinate and collaborate closely with plan medical directors and plan health services directors to ensure optimal transitions for members across settings and "CM levels" and pro-active "reach outs" to plan when there may be provider static over a decision or series of decisions
- Strong communication and coordination with other AMC and cross-segment program physicians and leads (e.g., Healthy First Steps, Optum NICU, United Healthcare Services, etc.)
- Actively participate in regional and national calls to support organizational improvement
- Identify opportunities to improve valued preventative care measures for members
- Assess and triage concerns about potential poor quality of care by hospital and/or physicians to appropriate ICCT or plan lead
- Contribute to goal of making AMC an excellent place to work through respectful relationships with team members - regularly highlighting team and individual accomplishments in regards to overall outcomes or on an individual member, and, highlighting opportunities for improvement in the most appropriate setting in a constructive, supportive way
Qualifications
Qualifications:
* Unrestricted Medical Licensed Physician required
* Requires Medical license in PA or eligibility to obtain MD licensure in PA
* Board Certification in an ABMS Specialty (preferred) OR equivalent training
* 5 years clinical practice experience required
* Utilization Management experience required
Additional Assets Preferred:
* Excellent telephonic communication skills; excellent interpersonal communication skills.
* Ability to develop relationships with network and community physicians and other providers.
* Strong knowledge of managed care industry.
* Excellent project management skills.
* Data analysis and interpretation skills.
* Ability to focus on key metrics.
* Excellent presentation skills for both clinical and non clinical audiences.
* Familiarity with current medical issues and practices.
* Creative problem solving skills.
* Visibility and involvement in medical community.
* Strong team player and team building skills.
* Supervisory skills including clinical mentoring and coaching skills
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
Job Clinical Analysis & Consulting
Primary LocationUS-PA-Pittsburgh
Organization AMC Regional ICCT - Northeast
Schedule Full-time
Number of Openings 1
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