Complex Medical Conditions is an OptumHealth Care Solutions company within UnitedHealth Group. Patients with complex, unusual or rare medical conditions have a likelihood of better outcomes when they are diagnosed and treated by medical professionals with the greatest experience and statistically validated clinical expertise. For more than a decade Complex Medical Conditions has been identifying costly, complex and catastrophic conditions for which there is a quantifiable variance among treatment providers. Our Centers of Excellence products and services are developed to support safe, successful and cost-effective management of patients with these conditions.

• The Complex Medical Conditions Medical Director is responsible for providing clinical leadership and oversight to neonates who are admitted to the NICU.
• Provides medical guidance for primary case management of chronic and acute conditions of neonatal infants while inpatient and post discharge.
• The Medical Director, in close collaboration with the Chief Medical Officer and Nurse Managers, helps ensure that the Complex Medical Conditions programs result in improved coordination of care and services for patients, thereby achieving established targets and goals.
• The Medical Director serves as the primary clinical educator and mentor for his/her unit through daily support of the NRS team .
• In addition, the Medical Director facilitates achievement of Complex Medical Conditions goals through peer-to-peer communication with both network and non-network physicians.

Responsibilities

• Actively participates in weekly Complex Medical Conditions team meetings for communication, feedback, problem solving, staff training and sharing of program results.
• Through the prioritization process, actively identifies cases for review and provides support for regular case review and rounding with the nurses to meet program goals as it relates to neonatal care
• Serve as a key contributor in data sharing for neonatal providers as well as hospitals to encourage best practices and outcomes.
• Develop and implement chronic disease management programs as identified by Complex Medical Conditions and serve as the clinical expert for those programs
• Conducts regularly scheduled sessions with the Complex Medical Conditions team to identify and address issues, such as delays and unresolved gaps in care.
• Is accessible to the Complex Medical Conditions team throughout the day to respond to clinical issues.
• Serves as clinical resource, coach and leader for Complex Medical Conditions team.
• Regularly engages in peer-to-peer dialogue concerning Complex Medical Conditions issues to develop collaborative intervention plans with both network and non-network physicians.
• Meets peer-to-peer intervention benchmarks.
• Documents case review findings, actions and outcomes in accordance with Complex Medical Conditions policies.
• Develops and delivers clinical education programs that address the specific needs of the NRS team.
• Together with the Complex Medical Conditions team, identifies and, when appropriate, assists in initial investigation and triage of quality of care and patient safety issues.
• Supports sales and marketing efforts through customer presentations related to Complex Medical Conditions process particularly as it relates to the neonatal resource services.
• Monitors both customer specific and product line reports, identifying changes in utilization and access patterns and developing targeted action plans.
• Upon request, communicates with customers about Complex Medical Conditions results and other customer related issues.
• Shares best practices with other Medical Directors and clinical leaders from other Complex Medical Conditions sites.
• Participates in design and development of Complex Medical Conditions programs and product development and national committees as directed by Complex Medical Conditions leadership

• Active, unrestricted MD license in U.S. required
• Board certification in ABMS specialty required
• Specialty in neonatology with experience in a neonatal intensive care unit strongly preferred
• Experience in a Medicaid managed care setting preferred
• Strong knowledge of managed care industry,
• Past experience working in a managed care company preferred
• Experience developing innovative approaches to medical care
• Sought out as expert in neonatal pediatric management
• 5+ years clinical practice experience required
• Superior presentation skills for both clinical and non-clinical audiences
• Excellent project management skills
• Solid negotiation and conflict management skills
• Basic proficiency with Microsoft Office applications

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