Optum

Network Medical Director - St. Louis, MO - Midwest RBE - Field-based with Travel

Saint Louis, MO

full-time
Inpatient and outpatient

Optum MO is seeking a Medical Director to join our team in St. Louis, MO. Optum is a clinician-led care organization that is changing the way clinicians work and live. As a member of the Optum Care Delivery team, you’ll be an integral part of our vision to make healthcare better for everyone.

Primary Responsibilities:

  • Leads onboarding discussions with new practices joining the network, focusing on setting appropriate and customized performance expectations in collaboration with the practice leaders
  • Establishes and messages clear standards and expectations for the professional performance of the provider/provider groups in their designated market(s) of the Midwest Risk Bearing Entity (RBE)
  • Collaborates in teaching clinicians and clinical operations teams about Medicare Risk Adjustment, CMS STARs/HEDIS, and overall population health approach to patient care in both formal presentations and off the cuff at impromptu opportunities
  • Seeks to align Risk Adjustment, Quality, and Affordability initiatives internally and translate into ways network practices can actively engage in easily using these resources
  • Operates with a tone of service and collaboration, leading their designated market(s)
  • Collaboratively works with the clinical and operational staff of the practices to develop strategies and design solutions to improve the value of care, clinical outcomes, affordability, and patient experience
  • Works with RBE leaders to support integration of Quality Improvement programs, Utilization Management reports, and Disease Management programs
  • Reviews and trends group/provider performance data to identify and strategize opportunities for improved performance
  • Reports out at the Value Based Care Council, Quality Committee, Regional Executive committee, or Provider Meetings as requested
  • Travel within their assigned state(s) on a regular basis as needed with occasional overnight travel

Required Qualifications:

  • M.D, D.O., or M.B.B.S.
  • Active unrestricted license to practice medicine in Missouri
  • Board certification in Family or Internal Medicine
  • 5+ years of recent clinic-based clinical practice experience after completing residency training
  • 2+ years of experience in a physician leadership role in medical facility or related environment preferred Well-versed in guiding conversations with clinicians, operations teams, and executive leadership in various organizations
  • Experience and knowledge of the local Missouri market
  • Knowledge of managed care, including risk adjustment, affordability, quality (STARs/HEDIS), utilization management, care management
  • Driver’s license and access to reliable transportation
  • Ability to travel, with occasional overnight travel

Preferred Qualifications:

  • Recent clinical practice experience in a Primary Care based setting
  • Advanced knowledge of Medicare Advantage and SNP/D-SNP programs
  • Ability to quickly customize the conversation with contracted groups at various stages of population health development
  • Proven track record of working well with Physicians, APRN, Physician Assistants, Coders, Schedulers, Managers, Directors, and Executives to assure care delivery is patient centered, timely, effective and evidence-based approach to clinical care across all Primary Care and specialty care participants
  • Solid understanding of local market and healthcare landscape

About Optum

Optum is the health care technology and innovation company of the UnitedHealth Group enterprise along with UnitedHealthcare. We’re a global organization that’s evolving health care so everyone can have the opportunity to live their healthiest life. With our hands across all aspects of health, we'll provide you with a rewarding career that enables you to grow in the directions that best fit your passions. This is your opportunity to be part of a team that’s dedicated to Caring. Connecting. Growing together.

Posted April 20, 2025

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