University of Utah Health Care

  • Medical Director, Quality & Medicare Advantage - University of Utah Health Plans

    Requisition Number
    35371
    Reg/Temp
    Regular
    Employment Type
    Full-Time
    Shift
    Day
    Work Schedule
    Per business needs
    Location Name
    University of Utah Health Plans
    Patient Care?
    No
    City
    Murray
    State
    UT
    Department
    UIP CST 01H UUHP CLINICAL OPRN
    Category
    Insurance / Health Plans
  • Overview

    This position works with multiple products within the University of Utah Health Plans, with a focus of overseeing Quality Improvement and Medicare Advantage. This position combines clinical expertise with financial stewardship to support U of U Health Plans programs.

     

    Department Overview: This position reports directly to the Chief Medical Officer- University of Utah Health Plans and supports the organization's goals and mission within Health Plans.

     

    Corporate Overview: University of Utah Health Plans covers approximately 200,000 members in Utah and the Mountain West Region. The plan offers services in Commercial, Individual Exchange, and Medicaid Markets. The University of Utah is a Level 1 Trauma Center and is nationally ranked and recognized for our academic research, quality standards and overall patient experience. Our four hospitals and seventeen clinics provide excellence in our comprehensive services, medical advancement, and overall patient outcomes.

     

    This position has no responsibility for providing care to patients.

     


     

    It's been a winning year...

     

    University of Utah Health was ranked 35th in the nation as one of America’s Best Large Employers by Forbes in 2018 and in 2019, and is the only health care provider from the state of Utah to receive the designation. 

     

    University of Utah Health credits its employees for its national ranking as a Top 10 Academic Medical Center for quality and safety for NINE consecutive years. 

     

    In addition to its placement on the Top 10 list, U of U Health placed fifth for Excellence in Ambulatory Care! This is the fourth year in a row the U has been ranked in the Top 5 for delivering high-quality, patient-centered, efficient and effective outpatient care.

     

    The University of Utah Hospital also received the award for the Best Hospital in Utah in 2018!  

     

    Not surprisingly, health care organizations with higher levels of staff engagement also have higher patient satisfaction scores, better staff retention, and a stronger culture of safety.  It’s a great place to work and live, and the nation is taking note!

     

    As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, diversity, integrity, quality and trust that are integral to our mission. EO/AA

    Responsibilities

    Accountability

    • Work with the Chief Medical Officer and UUHP leadership to help develop best practice and appropriate strategy to provide services related to Quality Improvement.
    • Assist to develop policies, procedures, and clinical programs for entrance into the Medicare Advantage market.
    • Combine clinical expertise and financial stewardship to grow and support U of U Health Plans programs.
    • Collaborate with business owners to expand Plan's lines of business including commercial, Medicaid, and Medicare.
    • Ensure services are built and maintained to meet regulatory standards as well as expectations of clients and members.

    Collaboration

    • Facilitate cooperative and collaborative community and institutional relationships, with internal and external customers.
    • Contribute as a key member of the leadership team and other committees addressing various strategic outcomes and initiatives and work activities across U of U Health Plan.

    Communication

    • Interface with clients to update on trends, risks, opportunities, and challenges related to healthcare services.
    • Proactively engage with all internal and external business partners to achieve plan goals and organization business objectives.
    • Work with providers to establish quality metrics, develop strategies to meet these metrics and updated providers on progress to meeting the metrics.

    Technical Development

    • Develop and maintain strategies consistent with evolving national programs, methodologies and technologies.
    • Collect and analyze data related to quality or performance improvement for UHHP services.

    Financial Management

    • Assist in developing, monitoring and achieving budget goals for Medicare and Quality Improvement activities.
    • Manage labor and non-labor expenses to budget or flex budget.

    Quality/EPE

    • Work cross-functionally with Clinical Care Services, Network Management, Member Services, Finance, Government Programs, and other leadership to meet and exceed quality and cost.
    • Work with Network Team to develop Alternative Payment Methodologies.
    • Promote physician/provider compliance with, recognized national guidelines, clinical pathways and protocols.
    • Analyze the department's performance and implement measures designed to improve performance.
    • Responsible for upholding PROMISE standards in all internal and external interactions.

    Performance/Human Resource Management

    • Provide staff feedback on performance, including on-time appraisals and coaching.
    • Recognize staff when appropriate.

    Relationships and Engagement

    • Form positive relationships with staff, physicians, peers, and senior leadership to support the mission, vision, values and performance standards of the organization.
    • Actively engage staff with updates and news as well as involving staff in decisions and work teams.

    Knowledge / Skills / Abilities

    • Ability to perform the KPIs of the position, as outlined above.
    • Demonstrated verbal and written communication skills.
    • Ability to communicate and collaborate with internal leaders and staff, as well as external stakeholders (delivery system and contracted providers) to achieve goals.
    • Knowledge of regulatory and standards of care related to health plans.
    • Demonstrated appreciation of cultural diversity and sensitivity towards target population.
    • Demonstrated understanding of managed health care delivery systems and operations and accreditation requirements.
    • Ability to maintain knowledge of accreditation standards and contractual obligations for performance and apply continuous quality improvement principles.
    • Demonstrated superior computer and data analysis skills including Microsoft Access, Microsoft Excel, and other financial & statistical software packages.
    • Demonstrated strong project management skills.
    • Demonstrated leadership skills including the ability to guide and manage change, and to accept responsibility for process improvement.
    • Demonstrated strength in team building, interpersonal skills, and the ability to initiate and maintain cross-department initiatives.
    • Demonstrated ability to deal with conflicts in a proactive manner and to reach resolution in a timely manner.
    • Ability to form positive relationships with staff, peers, and senior leadership to support the mission, vision, values, and performance standards of the organization.

    Qualifications

    Qualifications

    Required

    • Current licensure to practice medicine in the State of Utah. (M.D. or D. O.)
    • Board Certification in their field of specialty.
    • Two years of full-time clinical practice experience

    Qualifications (Preferred)

    Preferred

    • Experience with population health, case management, or managed care.
    • Experience in program development.

    Working Conditions and Physical Demands

    Employee must be able to meet the following requirements with or without an accommodation.

    • This is a sedentary position in an office setting that may exert up to 10 pounds and may lift, carry, push, pull or otherwise move objects. This position involves sitting most of the time and is not exposed to adverse environmental conditions.

    Physical Requirements

    Listening, Manual Dexterity, Near Vision, Sitting, Speaking, Standing, Walking

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