Reporting to the Chief Medical Officer of UnitedHealthcare, the Chief Medical Officer (CMO) for Community & State will leverage their proven track record to become the end-to-end owner of clinical programs and results for the Medicaid population. The Community & State CMO will be a member of the UnitedHealthcare Clinical Services (UCS) leadership team and represent the Community & State perspective, driving clinical data analysis, identifying opportunities and overseeing the design and implementation of programs that deliver value by improving clinical and cost outcomes. The CMO will collaborate with UCS and Healthcare Economics on using clinical insights and benchmarks in data-driven program design to monitor execution, evaluate outcomes, and create in-depth assessment of program performance.
The CMO will also be a member of the Community & State Executive Team. In that capacity, this position serves as senior clinical liaison on Medicaid-related topics with the Center for Medicare & Medicaid Services and State based Medicaid agencies, all clinical product offerings, clinical market strategies, and clinical support for sales and growth opportunities. The CMO will oversee development and implementation of initiatives to meet quality standards. Additionally, the CMO will provide leadership, facilitate collaboration and provide oversight for Community & State market-level CMOs, implementing national programs while supporting local innovation, and ensuring compliance with federal and state regulations. The CMO will also support RFP responses and participate in oral presentations, articulating the value story for Community & State’s clinical model, programs and results.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
- Accountable for market strategies to meet customer needs as end-to-end owner of the clinical product offerings for Community & State. Continuously improve and update the clinical model for program competitiveness, compliance, efficiency and affordability
- Collaborate with Market C&S CMOs, C&S clinical and operational teams and UCS to develop clinical model for all products
- Provide strategic clinical leadership of medical staff and programs throughout Community & State
- Monitor value and performance, regularly evaluating program outcomes, quality, affordability and operational results with defined metrics
- Use results to continuously improve program offerings
- Retool or replace ineffective programs
- Conduct quarterly deep dive review of clinical programs and model to ensure effectiveness
- Develop summaries of clinical programs and models with outcome metrics to support the RFP process
- Align with shared services capabilities to ensure consistency with federal and state mandates, including:
- State-based Medicaid programs including LTSS
- Medicare Advantage
- Medicare Supplemental plans
- Special Needs Plans
- Medicare-Medicaid Programs (MMP)
- Ensure total end-to-end affordability through understanding of trend and addressing value drivers. Meet affordability commitments through local health plans, shared services and delegates to implement network and local initiatives. Prospect within UHC for affordability programs not yet fully implemented within Community & State. Monitor the industry for emerging affordability plays. Develop pipeline of affordability initiatives. Goals include:
- Collaborate with UCS to establish affordability targets
- Ensure that local markets, shared services and delegates appropriately understand their accountability and have plans in place to meet/exceed targets
- Continuously evaluate trend and address key drivers
- Continuously monitor progress toward goals and adjust as necessary
- Participate with network and operations to achieve targeted savings on UCRT, recoveries, and Fraud and Abuse
- Develop pipeline of initiatives by participating in development across the business, mining playbooks, evaluating existing UHC programs not currently deployed to Community & State, and evaluating competitor strategies and behaviors
- Work with Market CMOs, UnitedHealthcare Networks (UHN), and business leaders to:
- Adapt the clinical strategy for different markets including state requirements on benefit design, network and clinical models
- Develop a clear evolutionary path from a fragmented FFS market to an integrated and incented market
- Provide local, regional and national cross-functional support, clinical insight and expertise to assist in Medicaid member growth
- Ensure services are delivered to members at the highest quality standards. Oversee and ensure development and implementation of initiatives to meet or exceed state standards and quality incentive programs. Work to continuously improve ratings/scores for quality, efficiency and care experience at bonus-level thresholds, HEDIS® quality standards, and accreditation standards through working with and holding Quality shared services accountable. Continuously improve Star Ratings, HEDIS®, and CAHPS® scores for members and providers
- Support the RFP process through clinical models and programs that will meet or exceed regulator and member expectations. Work with market leadership to understand competitor offerings and counter with superior programs. Develop a roadmap/pipeline of product offerings. Goals include:
- Review market opportunities for developing meaningful clinical programs to support local needs and RFP requirements
- Develop a pipeline of programs to meet emerging market requirements and competitor offerings designs and clinical programs, in collaboration with the field, UHN, Product and clinical shared services, for deployment in various and diverse market opportunities, including:
- Health and wellness
- Preventive health
- Member incentive programs
- Provider incentive programs
- Collaboration with Community Centers
- Medical Home / Accountable Care Communities
- Collaborate with Community & State CEO, Legal and Regulatory Affairs to develop and implement a proactive advocacy and relationship strategy to actively with CMS and state leadership, program directors, and other policymakers
- Oversee and ensure compliance with standards around prior authorization, utilization review, and appeals and grievances by working with and holding accountable compliance, UCS, Optum, and other clinical delegates
- Ensure deployment of capital to clinical programs to maximize returns on compliance, affordability, quality, and efficiency
- Represent Community and State and UHC in external speaking engagements both nationally and regionally, in support of Community and State business and clinical priorities
Demonstrable Skills and Experiences:
- Proven record of executive leadership in a state Medicaid agency, payer, health system or large practice group
- Experience in driving change and innovation though continually seeking and implementing innovative solutions; create a culture that thrives on continuous change; inspire people to stretch beyond their comfort zone; take well-reasoned risk; challenge "the way it has always been done"; change direction as required
- Ability to build a team through influence that values organizational success over personal success; drive exceptional performance by provide ongoing coaching and feedback; identify and invest in high potentials; actively manage underperformance
- Execute with discipline and urgency: deliver value to the customer; closely monitor execution; drive operational excellence; get directly involved when needed; actively manage financial performance; balance speed with analysis; ensure accountability for results
- Model and demand integrity and compliance
- Proven ability to execute and drive improvements against stated goals
- Ability to develop relationships with network and community physicians and other providers
- Visibility and involvement in medical community
- Ability to successfully function in a matrix organization
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.
- Active and unrestricted medical license
- Board Certified in an ABMS or AOBMS specialty
- 12+ years of clinical practice experience; strong knowledge of managed care industry
- 8 + years of experience in significant leadership role in large clinical or payer organization
- Excellent interpersonal communication skills; ability to influence in executive settings
- Strong written and verbal communication skills
- Superior presentation skills for both clinical and non-clinical audience
- Solid data analysis and interpretation skills; ability to focus on key metrics
- Strategic thinking with proven ability to communicate a vision and drive results
- Solid negotiation and conflict management skills
- Proficiency with Microsoft Office applications (Outlook, Word, Excel, PowerPoint)
- Ability to travel
- If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained.
- Advanced degree in Business, Public Health, or Medical Management
- Experience in Medicaid, Medicare Managed Care and/or alternative payment models
Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in healthcare here. We serve the healthcare needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV / AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive healthcare, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.(sm)
Colorado Residents Only: The salary range for Colorado residents is $300,000 to $350,000. The role is also eligible to participate in UHG’s annual bonus and long-term incentive plans. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Job Keywords: telecommute, remote, work from home, 927314