Morgan Consulting Resources is an executive search firm focusing on the Healthcare Industry for 15 years.  We have extensive experience in bringing together leadership talent of organizations that cover all aspects of Healthcare Services - Providers, Payers and Supporting Service organizations.  We have been retained by Universal American (UA) to find a Senior Medical Director; a position based at UA’s Medicare Advantage Division headquarters in Houston, Texas.

Universal American, a Fortune 500 company, is a family of specialty healthcare companies dedicated to working collaboratively with doctors, pharmacists and other professionals to improve the health and well being of its members.  The company offers a comprehensive and affordable array of healthcare products including Medicare Advantage health plans, Medicare Prescription drug plans, Medicare Supplemental insurance and TPA services.  There are currently four HMOs in three states.  The PPO plans are expanding into 29 states in 2010.  There are 175K members in Private Fee for Service plans across the US. Member Health, one of Universal American’s Part D plans is the third largest Part D plan in the country.  For more information about Universal American, please visit their website at www.UniversalAmerican.com/Who-is-UniversalAmerican.

The Senior Medical Director is part of a team including Senior Medical Directors, RN’s and care management professionals at the corporate level and in the regional field operations offices.  He/she will contribute to the overall Care Management Strategy and will play a role in executing on the care management strategies and programs.  There is some travel required to regional sites to provide oversight to the Field Medical Directors and Care Management staff in those offices.  Senior Medical Directors have the opportunity to take responsibility for specific segments of a recently developed medical management program and to become the subject matter expert on those segments of the plan.  There will be opportunities to develop innovative products and be involved in special projects that further the corporate goals around efficient, high quality medical management.  There are also opportunities to assume leadership of a specific unit within care management, such as Behavioral Health.  As the company grows, career opportunities could be available.

We seek an MD, Certified by the American Board of Medical Specialties in IM or FP preferable.  This medical professional will have five years experience in clinical practice and two years experience in managed care administrative duties and experience with Medicare Regulatory and compliance regulations.  We are looking for someone who is self-motivated, innovative and has an entrepreneurial spirit.  The Senior Medical Director position description is attached for your review.

Houston, Texas is the fourth largest city in the United States.  Houston shows its devotion to the arts through a full complement of art museums and galleries from ballet, theatre and symphony companies to some of the world's finest restaurants.  Houston is truly a cultural paradise.  The leading industry is the air and space trade.  They are also a city that loves sports and they boast more than 40 colleges, universities and institutions offering higher education options to suit all interests.

Whether or not this position is of interest to you, I would love to get your feedback and ideas.

Bev Meade, Principal

Morgan Consulting Resource, Inc.

702-968-8050

bev@morganconsulting.com

 

 

JOB DESCRIPTION 

                                                                                                                                       

Job Title:  Senior Medical Director, Corporate

Department: Medical Management

Reports To: CMO

FLSA Status: Exempt

Classification: Non – Officer

Prepared By: Human Resources/Morgan Consulting

 

Summary: 

 

The Senior Medical Director is part of a team that includes other Senior Medical Directors, RNs and care management professionals at the corporate level and in the field operations.  Although the primary responsibility of the Medical Director will be providing medical necessity opinions for initial organizational determinations and appeals, the successful candidate will also contribute to the overall Care Management Strategy and will play a role in executing on the care management strategies and programs.  He/she will travel to regional sites providing oversight, mentoring and coaching to the field Medical Directors and Care Management staff in the field offices.  Senior Medical Directors have the opportunity to take responsibility for specific segments of a recently developed medical management program and to become subject matter experts on those segments of the plan.  There will be other opportunities to develop innovative products and special projects that further the corporate goals around efficient, high quality medical management.  There are also opportunities to assume leadership of a specific unit within care management, such as Behavioral Health. 

 

Responsibilities:

• Provide first level Determinations and Appeals as needed for Medical Management Departments/all product lines.
• Provide first level Determinations and Appeals as needed for PBM/all product lines.
• Co-chair the Credentialing Committee and provide oversight as needed; Co-chair the Medical Policy Committee.
• Member of Quality of Care Committee and participate in Peer Review cases as needed.
• Assist the VP for Quality Improvement to develop and implement metrics and performance targets that assess compliance with CMS regulations and state regulations and best practices in medical management. 
• Participate in transplant review and new technology evaluations.
• Participate/active voting member and Co-chair the various health plans’ Quality Improvement Committees.
• Provide support and mentoring for regional Medical Directors and Medical Management personnel.
• Travel to current and new markets and make presentations as needed - up to 15% travel time.
• Works in compliance with Sarbanes-Oxley Act and adherence to company's Business Code of Ethics.
• Assist in the development and provision of all quality and medical management company objectives.
• Act as key contributor to reducing cost and improving the quality of healthcare. 
• Works with the VP for Quality, the Director of Performance Measurement and Analytics to refine and implement measurement system used in UA’s Pay for Performance Program.
• Evaluate and provide recommendations for the current Quality Improvement committee structure to improve efficiency and effectiveness of those bodies.
• Help identify business process redesign and simplification opportunities to increase business unit value and efficiency.
• Participate in the design and implementation of Care Management tools and products.
• Serve as an expert in review, analysis and reporting of clinical data and results.
• Maintain working knowledge of CMS and HIPAA regulations standards as applicable to Health Plan.
• Ensures that all contractual work conducted meets confidentiality and regulatory standards.
• Other duties as assigned by CMO.

 

Experienced Required:

 

• MD; Certified by the American Board of Medical Specialties in IM or FP.
• 7 years of clinical practice; clinical practice with the last 5 years a plus.
• 3 years experience in Managed Care administrative duties.
• Experience with Medicare regulatory requirements a plus.
• Health Plan Experience and Medicare Experience a plus.

 

Skills:

• Strong Clinical skills, ability to build relationships and credibility with other medical directors, RNs in the field and at corporate level.
• Ability to build relationships with providers in the local markets.
• Leadership, communication and presentation skills.
• Strong influencing and negotiating skills.
• Understanding of the business and financial impact of care management decisions and the ability to implement interventions to achieve desired outcomes.
• Ability to work with clinical data to influence behaviors, draw conclusions and improve overall outcomes.
• Ability to work effectively with vendors to achieve desired results.
• Self motivated, ability to work independently and collaboratively.
• Entrepreneurial spirit with a can do attitude.
• Innovative, willing to try new ideas and risk failure.

 

Education/Certifications:

• MD; DO required.  Current Medical License and ability to obtain in Texas Medical License required.
• Board Certification in Internal Medicine or Family Practice strongly preferred.  Geriatrics training a plus.
• MBA or MPH a plus.

 

Travel Required:

• Up to 15%.

 

Physical Demands/Work Environment:

 

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

Work is performed in a professional office setting, business casual dress environment. Working extended hours may be required as needed.  Extended periods of sitting and or standing, telephone work and/or computer work, as well as interactions with other staff members.  The noise level in the work environment is usually moderate.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The above statements are intended to describe the general nature and level of work performed by personnel assigned to this classification.  This description is not to be construed as an exhaustive list of all job duties performed by personnel assigned to this classification.

Universal American Corp. is proud to be an equal opportunity/affirmative action employer.  We are committed to attracting, retaining and maximizing the performance of a diverse and inclusive workforce.