Medical Director

LTSS Medical Director – Massachusetts

UnitedHealthcare Community Plan of Massachusetts is seeking a qualified LTSS Medical Director to provide ad hoc clinical coverage for its Long-Term Services and Supports (LTSS) programs.

This position is intended to serve as backup coverage for existing LTSS Medical Directors when they are unavailable due to PTO, medical leave, holidays, or unforeseen circumstances. The selected physician will be expected to learn the LTSS case review process and remain available to provide coverage when needed. The assignment is expected to require approximately five weeks throughout the year.

Reporting to the Chief Medical Officer (CMO), the LTSS Medical Director will provide clinical leadership with a primary focus on home and community-based services review, utilization management, and communication with network physicians and other providers.

Key Responsibilities:

• Review home and community-based services requests and determine appropriate approval or denial of services.
• Collaborate with nursing staff to clarify service requests and supporting documentation as needed.
• Represent the health plan in Board of Hearing cases.
• Provide appropriate utilization management and monitor outcomes of Care Management and Health Services interventions.
• Collaborate with Care Management, Health Services, and Behavioral Health teams to achieve utilization and clinical goals.
• Support an integrated clinical model across Behavioral Health and clinical management.
• Participate in clinical quality initiatives and peer review processes.
• Serve as a clinical resource and coach to support health plan programs and organizational goals.
• Collaborate with the CMO, clinical operations, and market teams to achieve clinical and operational objectives.
• Provide clinical leadership related to home and community-based services and external communication with network physicians.
• Assist with development and implementation of local clinical policies and procedures, quality improvement initiatives, and performance improvement projects.
• Support strategic clinical initiatives and other responsibilities as assigned.

Required Qualifications:

• Active and unrestricted Massachusetts Physician License.
• Board Certified in an ABMS- or AOBMS-recognized specialty.
• 5+ years of clinical practice experience.
• Strong knowledge of the managed care industry and Medicaid line of business.
• 2–3 years of quality management experience.
• Familiarity with current medical issues and clinical practices.
• Strong leadership and team-building skills.
• Excellent interpersonal and communication skills.
• Strong presentation skills with both clinical and non-clinical audiences.
• Proven ability to build relationships with network and community physicians and other providers.
• Excellent project management skills.
• Strong data analysis and interpretation abilities with a focus on key performance metrics.
• Strategic thinking and the ability to communicate a vision and drive results.
• Strong negotiation and conflict-management skills.
• Creative problem-solving abilities.
• Proficiency with Microsoft Office applications.

Ideal Candidate:

The ideal candidate is an experienced physician with a strong background in managed care, Medicaid, quality management, and utilization management, who is comfortable working within a highly matrixed healthcare organization. The candidate must be willing to learn the LTSS case review process and provide ad hoc coverage, including holidays, when the primary LTSS Medical Directors are unavailable.

This is an intermittent backup coverage opportunity rather than a traditional full-time Medical Director position, with approximately five weeks of coverage anticipated throughout the year.