OptumHealth 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. OptumHealth is a leading provider of emotional wellness services. With us you can improve the health of others and help heal the health care system. You can work with an incredible team culture; a clinical and business collaboration that is learning and evolving every day. When you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere. This full-time position is responsible for a significant amount of direct facing customer contact with our client, Harvard Pilgrim, and whose regular presence will be required at major providers in the Boston area to include working on-site at the client offices. The Associate Medical Director will also be responsible for providing oversight and direction of the Utilization Management Program and performing peer reviews as necessary. They are involved in the development and implementation of medical expense initiatives, advising leadership on improvement opportunities regarding medical expense programs as well as clinical activities. Primary Responsibilities:Serve as primary dedicated MD/clinical contact for Harvard Pilgrim Health Care account Develop and participate in clinical and quality management processes and implementation of UBH's clinical policies Develop coordination of care rounds with HPHC's care management staff and chair weekly meetings Assist with article writing for the client's member and provider communications Contribute to Optum's content for HPHC's client presentations Participate in the development of clinical programs and have an impact on population heath management Work closely with managers and senior level staff internally and externally Oversee reviews in support of Optum case management activities including inpatient hospitalization and other acute care services Keep current with respect to treatment policies, guidelines and philosophies Support the activities of the Provider Service staff in the development and maintenance of an adequate provider network, including involvement in credentialing, quality improvement activities and network development activities Available for peer to peer review consultation with network and non-network providers Represent OptumHealth through regular participation on client meetings, committees, associations, etc Conduct reviews and make determinations on appeals
Required Qualifications:Medical Degree with an active, unrestricted license in the state of Massachusetts Board certified in psychiatry Minimum of three years of experience as a practicing psychiatrist Highly professional, poised and resilient in high level management interactions and creative problem resolution Strong presentation skills for both clinical and non-clinical audiences Accessible and visibly involved in the medical community Working knowledge of short-term outpatient methodologies and case managementBy providing 58 million Americans with information, tools and solutions, we are helping to guide them through the health care system, financing their health care needs, and enabling them to achieve their personal health and well-being goals. At OptumHealth, you will perform within an innovative culture that's focused on transformational change in the health care system. You will leverage your skills across a diverse and multi-faceted business. And, you will make contributions that will have an impact that's greater than you've ever imagined. 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. Job Keywords: Clinical, Psychiatry, Psychiatric, Massachusetts, Medical Director, Utilization, Boston, MA, Massachusetts, Wellesley
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.