среда, 29 августа 2012 г.

Inpatient Medical Director-Phoenix

Inpatient Review 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 members 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 west 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 United Health Care 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

Actively participate in site based and regional governance meetings addressing Health care affordability Initiatives
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 United Health Care 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.

UnitedHealthcare, part of the UnitedHealth Group family of companies, is comprised of three specialized businesses dedicated to meeting the health care benefits needs of individuals and groups; all part of something greater, but each with a specialized focus:

UnitedHealthcare Employer & Individual works with individuals, small businesses and large multi-site employers to provide innovative, affordable benefits services.

UnitedHealthcare Medicare & Retirement is focused on serving Americans over the age of 50. It is the largest business dedicated to meeting the growing health and well-being needs of aging individuals in the nation, serving one in five Medicare beneficiaries through a comprehensive and diversified array of products and services through four industry-leading businesses.

UnitedHealthcare Community & State provides high-quality, personalized, public-sector health care programs that help local government agencies improve health outcomes for millions of children and low-income and disabled individuals at an affordable cost.

Together, were removing the barriers that keep people from receiving the kind of quality health care that makes a difference. We focus on Integrity, Compassion, Relationships, Innovation and Performance as we empower people to achieve better health and well-being.

Come grow and thrive in our culture of innovation and ideas. Because there is no opportunity greater than the quest to help people live healthier lives.  Requirements-MD or DO with an active, unrestricted license

-Board Certified or Board Eligible in an ABMS or AOBMS specialty

-5+ years clinical practice experience -Intermediate or higher level of proficiency with managed care

-2+ years Quality Management experience

UnitedHealthcare, part of the UnitedHealth Group family of companies, is comprised of three specialized businesses dedicated to meeting the health care benefits needs of individuals and groups; all part of something greater, but each with a specialized focus:

UnitedHealthcare Employer & Individual works with individuals, small businesses and large multi-site employers to provide innovative, affordable benefits services.

UnitedHealthcare Medicare & Retirement is focused on serving Americans over the age of 50. It is the largest business dedicated to meeting the growing health and well-being needs of aging individuals in the nation, serving one in five Medicare beneficiaries through a comprehensive and diversified array of products and services through four industry-leading businesses.

UnitedHealthcare Community & State provides high-quality, personalized, public-sector health care programs that help local government agencies improve health outcomes for millions of children and low-income and disabled individuals at an affordable cost.

Together, were removing the barriers that keep people from receiving the kind of quality health care that makes a difference. We focus on Integrity, Compassion, Relationships, Innovation and Performance as we empower people to achieve better health and well-being.

Come grow and thrive in our culture of innovation and ideas. Because there is no opportunity greater than the quest to help people live healthier lives.

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.
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Country: USA, State: Arizona, City: Phoenix, Company: UnitedHealth Group.

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