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AZ Network Medical Director (Phoenix)

Optum
Phoenix, AZ
Optum AZ is seeking a AZ Network Medical Director to join our AZ Network team. 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.

At Optum, you'll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together.

Optum is the largest network of health care providers in the United States, whose mission is to connect and support providers by working together to deliver the most effective and compassionate care to each and every patient they serve. Optum's focus is to do the right things for patients, physicians, and the community. Optum's Core Business is contracting directly with health insurers to deliver a highly personal care management and service model to their patients. A main focus of Optum is on seniors, and those with complex care needs, who most benefit from a high touch model of care.

The IPA Medical Director in AZ will report to the AZ CMO. The IPA Medical Director will assist in directing the clinical strategy in the market to support and enable Independent Practice Affiliate Physician Offices of Optum to enhance the delivery of care in a value-based population health care environment. This individual will work to build solid, trusted relationships with other providers to influence and change behavior in a collaborative way. The Medical Director will be required to work cross-functionally and will be expected to provide insight and perspective from the network point of view to the CMO and leadership team. They will support the CMO with utilization management (UM), prior authorization determinations, oversight and direction of inpatient and skilled nursing facility utilization, oversight and direction of Outpatient Care Management Services, Medicare Risk Adjustment Factor (RAF) education as well as HEDIS/STARS education, and provider/group relationship building. This individual may be meeting with providers in the care delivery setting and will work with them and the CMO to identify opportunity for improvement in clinical documentation, coding and effective utilization.

Primary Responsibilities:
  • Assist in RAF/HEDIS/STARS education to improve metrics
  • Strategic leadership over the Independent Practice Affiliate Program in Arizona
  • Apply understanding of patient care quality metrics to enhance clinical outcomes (e.g., HEDIS; 5 STAR; disease-based metrics) in order to drive/achieve quality outcomes
  • Supporting all clinical quality initiatives and peer review processes
  • Effectively engaging and bringing understanding to our external constituents such as physicians, medical and specialty societies, hospitals and hospital associations, and state regulators
  • Identifying opportunities through participation in local medical expense committees or market reviews
  • Provide assistance in appeals review where appropriate
  • Leading and building the team responsible of oversight of the HEDIS data collection process, CAHPS (Consumer Assessment of Healthcare Providers and Systems) improvement, and drive
  • Health Plan accreditation activities
  • Travel will include Phoenix, Tucson & Yavapai mainly with expectation of Tuesday, Wednesday & Thursday to be visiting member clinics

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:
  • MD or DO with an active, unrestricted license in AZ or ability to obtain one
  • 5+ years of clinical practice experience
  • Experience and knowledge of Medicare Advantage programs (STARS, RAF, HEDIS, CHAPS/HOS etc)
  • Experience with identifying Medicare risk adjustment and presenting findings to client/providers
  • Experience with patient care quality metrics (e.g., HEDIS; 5 STAR; disease-based metrics) in driving/achieving quality outcomes
  • Working knowledge of managed care, and value based medicine
  • Proven ability to strategically lead regionally to ensure accurate diagnostic codes in order to maximize risk adjustment (RAF)

Preferred Qualifications:
  • 2+ years of Quality Management experience
  • Experience within managed care
  • Proven working with senior leadership team to strategize and assess market trends etc.
  • Proven to collaborate with Market Operations and Provider Relations staff in the market(s)
  • Proven to assists in the identification of potential physician practice acquisitions in assigned market
  • Proven in partnering with the Clinical Affordability team to support new innovative approaches to making healthcare more efficient and meaningful to PCPs and patients alike; ultimately bending the cost curve in region
  • Proven in developing and cascading clinical outcome/improvement messaging to business units to foster tighter working culture
  • Proven in helping set agendas/strategies and leading multifaceted teams of Physician Business Managers, Risk Adjustment RNs, and Quality RNs
  • Proven to assist driving aligned performance in largely an independently contracted provider network through the development of meaningful relationships, financial and quality incentives, best practices, forward thinking solutions to improve our value proposition to medical providers
  • Proven to assist in the identification and development of current/new best practices in support of continuous financial and quality improvement
  • Proven to serve as an integral dyad partner interfacing with Corporate level support divisions, to include: Quality, Risk Adjustment, Cost and Care

Compensation for this specialty generally ranges from $269,500 to $425,500. Total cash compensation includes base pay and bonus and is based on several factors including but not limited to local labor markets, education, work experience and may increase over time based on productivity and performance in the role. We comply with all minimum wage laws as applicable. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives.

OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. #J-18808-Ljbffr
Posted 2025-08-21

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