Neighborhood Physician - Post

The role of the Neighborhood physician is to manage primary care for complex Community Based patients within their assigned neighborhood (s) with an interdisciplinary care team. He/she will demonstrate excellent customer service and work in partnership with healthcare delivery stakeholders to improve smooth transitions of care. This position will complete home and clinic visits based on standard work flow requirements including productivity standards and clinical indicators for care. The neighborhood physician will collaborate with the CDQI department to complete or designate IDT members to meet HEDIS measures, RAF, immunization requirements, create advanced life plans and positive patient satisfaction in their neighborhood. Through monthly meetings with Sr. Medical Director he/she will report how their assigned care team has managed readmission, direct acute admissions and quality improvement activities for their assigned neighborhood(s). The Neighborhood Physician will participate in financial performance of their neighborhood.

Primary Responsibilities:

• Meet productivity and task measures as assigned by the Sr. Medical Director
• Meet with IDT teams weekly to review patient progress in medical treatment. Identify patients that will require a physician visit and determine with the RN Coordination Manager if the assigned IDT resources are working towards optimal performance
• Identify patients that may require Sr. Medical Director Evaluation and discuss alternative plans for optimal management of the patient
• Provide checklist of discharged patients for the Sr. Medical Director weekly for appropriate disposition
• Evaluate and assign appropriate level team members to complete RAF, HEDIS and customer care with the Case Manager RN Coordinator
• Assist in the development of the all of the IDT team member's standard work flow
• Complete tasks, medication refill orders and physician required home care orders within Lean standard goals
• Audit clinical competency of the NP thru supervisory visits and chart reviews. Develop standard workflow for the NP
• Mentor and teach IDT members towards clinical excellence
• Evaluation Patient satisfaction reports and reward high performers on their work for the neighborhood
• Participate in a rotation of post acute provider call for primary care for complex Community based program patients
• Evaluate after hour call report for neighborhood assigned patients with the RN Manager to determine prevention plans
• Ensure that all pertinent documentation is in the medical record in a manner compliant to policy
• Provide the clinical staff with on-going clinical education/updates to enhance understanding of acute and chronic medical conditions and follow evidence based medicine
• Direct efforts toward specific patient goals of care, along with Advance Directive discussions and Polst reviews/completion
• Performs duties within state and federal regulatory guideline, Optum/United pol icy and in accordance to scope of practice
• Other duties as assigned to in Optum national program meeting/task forces and other meetings in accordance with job description

Required Qualifications:

• M.D. Board Certified in a postgraduate clinical specialty
• Licensed to practice without restriction by the Nevada State Board of Medical Examiners
• Broad and comprehensive knowledge of medical management principles and insurance products for multiple and varied lines of business in a managed care environment
• Strong knowledge of the community health care environment, the provider network and the managed care contracting processes
• Good understanding of managed care systems, quality improvement and risk management
• Demonstrated excellent medical management, leadership skills and excellent communication skills
• Good skills in making presentations and teaching required. Strong organizational and prioritization skills
• Ability to make medical necessity decisions based on Medicare coverage criteria
• ACLS/BLS
• Minimum of 5 years of medical experience
• Minimum of 1-2 years of progressively responsible management experience preferably in a managed care setting
• Additional training in medical management

Preferred Qualifications:

• Bilingual and cultural competency

Expectations:

This physician will be required to complete clinical work at .9 and complete administrative functions in .1 of the FTE allotted time. Administrative duties are as follows:

• IDT leader for neighborhood management of patients
• Complete ride along supervision for post acute providers/clinician to give input on specific patient concerns, improve upon workflow processes, and aid in improving integration with SMA
• Charts audits for quality and provider feedback
• Identify standard workflow issues with team members
• Address provider HR related issues of direct reports
• Review monthly clinical outcome metrics, financial trajectories, and strategize for achieving optimal targets

Competencies for High Performers

Collaborative management of patients in a dynamic team approach

Influence care of patients with direct and indirect management techniques

Drive outcome metrics positively for patient satisfaction and financial measurement

Excel in clinical quality standards for home based care

Nevada Residents Only: The salary range for this roleis $249,728 to $355,092 per year. Salary Range is defined as total cash compensation at target. The actual range and pay mix of base and bonus is variable based upon experience and metric achievement. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.

Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.