Medical Director for Clinical Risk & Value - Remote

About the position

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. This opportunity is an important clinical leadership position reporting to the National Medical Director/CMO. The Medical Director for Clinical Risk Value is responsible for diverse functions with a primary scope related to creation of clinical guidelines, workflows, and leading clinical risk adjustment program enablement within the organization. This role represents Optum's Risk Value Ops Department.

Responsibilities

• Lead the development, prioritization, and annual review of clinical guidelines and workflows to support clinical risk adjustment related program development and deployment
• Deliver high-value, best-in-class clinical guidelines that serve as the foundation for multiple clinical programs
• Analyze medical and clinical evidence; critically assess scientific research and real-world outcomes to develop objective and unbiased guidelines
• Demonstrate solid skills in synthesizing and integrating information from multiple sources
• Apply a deep understanding of research study design and the quality of clinical evidence
• Provide subject matter expertise and guidance to the Clinical Guideline Review Participate in clinical decision-making on guidelines and programs with subject matter experts and stakeholders
• Focus on increased transparency and administrative simplification in guideline development
• Monitor regulatory changes and healthcare trends to ensure guidelines remain compliant and innovative
• Develop and implement clinical workflows based on clinical guidelines
• Ensure workflows are efficient, scalable, and aligned with organizational goals
• Continuously monitor and refine workflows based on performance and feedback
• Develop and implement operational enablement, including supporting technology (e.g., EMR), vendor management, procurement, billing, and incentives
• Collaborate with IT and operations to enable workflows through technology and process improvements
• Coordinate organizational procedures to optimize efficiency and productivity
• Collaborate across national, regional, and local teams to align goals, strengthen partnerships, and build effective feedback processes
• Establish business relationships to ensure deliverables are met and priorities are aligned
• Provide support in socializing guidelines and implementing programs
• Provide clinical expertise and guidance on risk adjustment initiatives
• Monitor and evaluate the effectiveness of guidelines in improving risk adjustment accuracy and clinical outcomes
• Analyze the clinical impact of programs on patient care and outcomes
• Identify priorities through data and advanced analytics research
• Support the creation and review of clinical education and training materials based on new or revised guidelines
• Provide training and support to clinical staff on new workflows and guideline implementation
• Keep up to date on medical literature
• Lead the development of summaries of current medical literature
• Support educational events
• Develop modern training and dissemination vehicles such as webinars, e-learning modules, and interactive case studies
• Serve as a subject matter expert in evidence evaluation, research methodology, and clinical decision-making
• Leverage technology to advance the creation, dissemination, and effectiveness of evidence-based medicine educational content

Requirements

• Active/unrestricted Medical Degree and License in primary specialty
• Board certification
• 5+ years clinical experience providing patient care
• 2+ years Medicare Advantage risk adjustment and clinical guideline experience
• Experience in motivating and influencing others at all levels within the organization
• Thorough understanding of evidence-based medicine, with extensive experience in critical review of the medical literature and/or medical research publications
• Proficiency working in a matrix environment, with demonstrated ability in systems thinking and enterprise insight to solve complex business problems
• Demonstrated ability to think strategically, with proven ability to drive results
• Proven solid critical thinking and analytic skills
• Proven skills in communicating effectively and efficiently (both verbal and written)
• Proven leadership during organizational change to drive transformation effectively in a fast-paced environment, while being adaptable and assisting individuals through the transition
• Demonstrated growth mindset in being open and able to break through barriers, while having an ability to leverage innovation
• Proven extensive record of performance, by meeting and exceeding established goals
• Proven solid data analytic skills
• Demonstrated ability to make strategic, operational, and administrative decisions in response to emerging conditions and environmental circumstances
• Proven ability to provide recommendations and insight regarding improvements to internal and external processes
• Proven ability to manage multiple competing priorities

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution