Senior Medical Director - AmeriChoice - Wisconsin

UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health.AmeriChoice, a UnitedHealth Group company, is a recognized leader and innovator in providing managed health care solutions to its Medicaid membership.  With over a decade of growth and success we are poised for continued expansion of our services in this dynamic marketplace. Our commitment to this specialized market makes a genuine difference in thousands of lives. Join us, do rewarding work, and build a great career. We need leaders in our organization who are passionate about serving this important population, and who can inspire others to continually reach for higher levels of patient care and satisfaction.  Are you one of those leaders? The Medical Director provides medical oversight, expertise, leadership and direction for the administration of the AmeriChoice/United disease management program to ensure the delivery of quality health care services as defined by state contract and national and local standards.  The Medical Director oversees and directs medical services division personnel and also serves as a liaison with State medical leadership and other stakeholders. Provides leadership and medical expertise in the development, implementation, and medical interpretation of medical/quality/disease management policy, procedure, and guidelines. Provides oversight and direction of provider education, training, and orientation. Participates in provider profiling functions, identifies disease management trends, and potential gaps in care and takes corrective action. Ensures processes in place for confidentiality of medical records, client information, and treatments. Provides medical guidance and supervision of disease management and case management service activities. Reviews all actual and potential quality of care issues and oversees the development and implementation of activities to improve the quality of care provided to members. Oversees the program’s disease management and case management functions. Monitors and tracks program performance indicators to ensure that cost-effective care is being provided with defined quality standards. Works in coordination with the Manager or Director of Medical Services. Evaluates over-utilization of the emergency room and the abuse by patients. Participates in audits when appropriate. Participates in management team functions. Responsible for the development of corporate clinical care standards and medical practice guidelines and protocols. Monitors and tracks  program performance indicators to ensure that cost-effective care is being provided within defined quality standards. Serves on committees, when and where necessary. Excellent telephonic communication skills; excellent interpersonal communication skills. Ability to develop relationships with network and community physicians and other providers. Strong knowledge of managed care industry. Excellent project management skills. Data analysis and interpretation skills. Ability to focus on key metrics. Excellent presentation skills for both clinical and non clinical audiences. Familiarity with current medical issues and practices. Creative problem solving skills. Visibility and involvement in medical community. Strong team player and team building skills. Unrestricted medical licensed physician; Board Certified in ABMS specialty 5+ years clinical practice experience. Supervisory skills including clinical mentoring and coaching skills.When you become part of AmeriChoice, you also become part of something larger—a Fortune 100 leader with a broad spectrum of services and products—while still working for a company where you can see and feel your impact. It's the best of both worlds.  If this is not the right opportunity for you at this time, please share it with the people you know who could excel in this role, and keep looking for the right opportunity for yourself at UnitedHealth Group. UnitedHealth Group is a drug-free workplace.  Candidates are required to pass a drug test before beginning employment.Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V