One of five regions in the Optum nationwide network, Optum Tri-State comprises three large multispecialty groups, CareMount Medical, ProHEALTH NY, and Riverside Medical Group. Optum Tri-State brings patients local care, backed by national expertise. As a premier provider of health care services, Optum Tri-State offers services including primary care, urgent care, a diverse range of specialty care, outpatient surgery, and imaging. The regions draws on the knowledge of leading doctors and healthcare experts to help 1.6 million patients across 630 locations access high quality, affordable healthcare within their community.
Job Summary: The Senior Medical Director for the IPA is responsible for leading the IPA clinical model and developing / maintaining the clinical relationships required for it to be successful. The role will focus on building relationships, growing the network, and accelerating the IPA's success in close partnership with operational, network and finance leaders. The selected individual must be:
- A teacher, mentor, and a sounding board for the IPA providers.
- A leader within the IPA as it develops and grows.
- An advocate for the IPA doctors.
- A champion of the Optum Care's Clinical Model and evidence-based medicine.
- A partner to other IPA leadership.
Essential Duties & Responsibilities include :
- Aligning IPA physicians to the Optum Care mission and vision.
- Physician education on the principles of value-based care with an initial focus on Medicare Advantage (MA).
- Develop and share clinical report cards, and partner with IPA providers on action plans to achieve the quadruple aim.
- Promoting the core tenants of the Optum Care Clinical Model which include:
- Lead healthcare transformation as physicians /clinicians.
- Align incentive frameworks for providers.
- Create an evolutionary roadmap to move providers along the change continuum.
- Support decisions at the point of care, where
- Follow evidence-based pathways .
- Measure our actions and our outcomes .
- Remain agile and
- Leverage best practices from our history of excellence to realize the Optum Care clinical
- Facilitate and coordinate wholistic and integrated person care .
- Remain safe, effective, patient-centered, timely, efficient and equitable
- Balance quality, cost, patient, and provider experience in pursuit of the Quadruple Aim .
Required Qualifications:
- Active Medical License/eligibility in the state of NY
- Board Certified
- 7+ years with direct patient care preferably in primary care
- 5+ years medical leadership preferable as a medical director or CMO leading care coordination
- Excellent written and presentation communication skills
- Familiarity with Medicare Advantage including HEDIS/Star and Risk Adjustment
- Familiarity with the principals of medical management including Prior Authorization, Case Management, and Disease Management.
- Strong EQ with proven influence management and negotiation skills.
- Proven ability to manage and drive team performance both in a direct and matrixed environment.
- Proven ability to quickly gain credibility, influence, and partner with clinical and business leaders.
- Excellent judgment, problem resolution, team building, negotiation, conflict resolution, budgeting, decision-making, & experience working under deadline pressure.
- Ability to tell a story via WebEx /Teams.
- Willingness to travel to IPA offices frequently/daily in assigned territory.
- Willingness to travel outside of immediate territory up to 25% of the time (requiring overnight stays).
Preferred Qualifications: Familiarity with the NY healthcare market, Primary Care physician, Healthcare payer experience.
Full COVID-19 vaccination is an essential requirement of this role. CareMount will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance.
All qualified applicants will receive consideration for employment without regard to race, ethnicity, color, religion, sex, gender identity, sexual orientation, national origin, disability, or protected veteran status. CareMount is an EEO employer - M/F/Veteran/Disability
