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Looking for a chance to drive measurable and meaningful improvement in the use of evidence-based medicine, patient safety, practice variation and affordability? You can make a difference at UnitedHealth Group and our family of businesses in serving our Medicare, Medicaid and commercial members and plan sponsors. Be part of changing the way health care is delivered while working with a Fortune 6 industry leader.
The C&S Plan Chief Medical Officer has accountability for ensuring that local health plan, United Clinical Services and UHC initiatives focusing on clinical excellence, quality ratings improvement, appropriate inpatient and outpatient utilization, health care affordability, health system transformation including provider network issues, mandated provisions and compliance, growth and focused improvement are implemented and successfully managed to achieve goals. This position reports to the local C&S plan President and has dotted line relationships to the C&S Chief Medical Officer and UCS market-assigned Regional Chief Medical Officer. The C&S Plan CMO’s primary responsibilities are directed towards C&S plan activities as defined by the C&S plan CEO, and also collaborates with United Clinical Services (UCS) staff including the regional Chief Medical Officer, and other market and regional matrix partners to implement programs to support and meet market C&S, UCS/ UHC and line of business goals.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Quality and Affordability – The Plan CMO has primary responsibility and accountability for Total Medical PMPM performance and targets for the local C&S plan. This will require a close working relationship with UCS clinical operations teams as well as with the C&S and UCS national affordability team. Activities will include conducting hospital Joint Operations Committee meetings with Network, contributing to--and implementing--regional Medical Cost Operating Team (MCOT) decisions, data sharing with physicians and physician groups on quality and efficiency improvement opportunities, and implementing local Health Care Affordability Initiatives. The Medical director will serve as clinical lead for healthcare affordability initiatives at the local market and establishing a process for sharing data with hospitals and physicians and completing peer to peer communications as required. Additionally, the Plan CMO has primary responsibility to oversee new clinical model operations including ACC Accountable Care Community relationships, Target setting JOC leadership. Support UHN initiatives and Quality Affordability Programs as required to achieve the appropriate inpatient and outpatient utilization and affordability goals of the C&S Health Plan and United Clinical Services/ UHC. The Plan CMO has oversight responsibility of the C&S market peer review process as defined by State regulator as well as participating in or leading the Peer Review committee
Clinical Excellence – The C&S plan CMO helps oversee the HEDIS data collection process, STARs clinical collection process, CAHPS improvement, and drive Health Plan accreditation activities as well as quality rating initiatives for the local CMS plan. The plan CMO is accountable for HEDIS and Stars performance for the Local C&S plan. This Medical director may also act in a similar capacity for Non-C&S HEDIS, STARs as directed by UCS regional CMO. Acts as an improvement catalyst for all quality-related efforts including Center for Medicare and Medicaid Services Star initiatives. Communicate to providers on new focus and measure/process changes. Supports all Clinical Quality initiatives and peer review processes including Quality of Care and Quality of Service issues
Relationship Equity and State Compliance—The Plan CMO maintains a solid working knowledge of all government mandates and provisions for the local C&S market, as well as working across the enterprise to implement and maintain compliant clinical programs and procedures. S/he also is committed to being effectively engaged with our external constituents such as consumers/members, physicians, medical and specialty societies, hospitals and hospital associations, federal/state regulators, and market-based collaborative. The CMO will work collaboratively in these activities with ongoing UCS initiatives under the aegis of UCS Regional CMO. The Plan CMO will be the outward face to State regulators based upon Contract, and direction of Plan President and C&S CMO
Innovation—The Plan CMO leads the clinical interface with care providers and UHC network management colleagues in efforts to transform the health system. Primary local responsibility is to drive Accountable Care Community (ACC) growth through identification of appropriate practices; initial contact and target setting, and Implementation, as well as ongoing leadership of monthly JOCs. Knowledge of Value Based contracting variants for C&S will be essential Secondary responsibility will include but not limited to, UHC’s Accountable Care Platform, clinical practice transformation, patient-centered medical homes, accountable care organizations, creative care management programs, high-performance networks and network optimization, and consumer engagement
Growth – This medical director delivers the clinical value proposition focused on quality, affordability, and service, in support of growth activities of the C&S Health Plan and the plan CMO reviews and edits communications materials as required and represents the voice of the market-based customer in program design. The Plan CMO actively promotes positive relations with State/local regulatory authorities and Medical Societies and records such in PEI tool
Focused Improvement –The Plan CMO is responsible for identifying opportunities through participation in regional and local Medical Cost Operating Teams or Market reviews, National MCOT. S/he actively participates in Joint Operating Committees. S/he also provides local feedback on, and oversight of the performance Optum Behavioral Solutions and Optum Health as needed. Additional responsibilities include the timely collection and entry of information into Online Engagement Survey tools and scorecards; developing action plans for sub-optimal results; and taking a leadership role in Quality Affordability Programs initiatives
Grievance and Appeals- the Plan CMO maintains an active liaison with UCS G&A and is responsible for representing the Local C&S plan at State Fair Hearings
Demonstrable Skills and Experiences:
- Ability to build a team that values organizational and Plan success over personal success; provide ongoing coaching and feedback to ensure peak performance; identify and invest in high potentials, actively manage underperformance
- Focus staff on the company's mission; inspire superior performance; ensure understanding of strategic context; set clear performance goals; focus energy on serving the customer; provide ongoing communication to the team; discontinue non-critical efforts
- Drive disciplined fact-based decisions
- Execute with discipline and urgency: Drive exceptional performance; 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
- Drive 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
- 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
- Deliver value to members by optimizing the member experience and maximizing member growth and retention
- Lead and influence Health Plan employees by fostering teamwork and collaboration, driving employee engagement, and leveraging diversity and inclusion
- Develop and mentor others while also building awareness to your own strengths and development needs
- Influence and negotiate effectively to arrive at win-win solutions
- Communicate and present effectively, listen actively and attentively to others, and convey genuine interest
- Lead change and innovation by demonstrating emotional resilience, managing change by proactively communicating the case for change and promoting a culture that thrives on change
- Play an active role in implementing innovation solutions by challenging the status quo and encouraging others to do so
- Drive sound and disciplined decisions that drive action while effectively using financial knowledge and data to manage the business
- Drive high-quality execution and operational excellence by communicating clear directions and expectations
- Manage execution by delegating work to maximize productivity, exceed goals and improve performance
- Excellent interpersonal communication skills
- Creative problem-solving skills
- Solid team player and team building skills
- Strategic thinking with proven ability to communicate a vision and drive results
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/unrestricted Colorado Medical License Active/unrestricted Board Certification in family medicine, pediatrics, psychiatry, OB/GYN and/or emergency medicine
- 5+ years of clinical practice experience
- Solid knowledge of managed care industry and the Medicaid line of business
- Experience in Value Based Contracting / Risk contracting
- Familiarity with current medical issues and practices
- Superior presentation skills for both clinical and non-clinical audiences
- Proven ability to develop relationships with network and community physicians and other providers
- Demonstrated excellent project management skills
- Solid data analysis and interpretation skills
- Proven ability to focus on key metrics
- Demonstrated negotiation and conflict management skills
- Proficiency with Microsoft Office applications
- Resides in Colorado and available for routine, in-person contact with market-teams, network providers, stakeholders, and regulators
- Demonstrated experience with behavioral health delivery, SUD treatment, child welfare, pharmacy management and related regulatory areas (ex. Parity)
- Demonstrated knowledge and professional experience with Medicaid managed care
- Experience with UHC and/or Optum clinical operations and medical leadership
- Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation
To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment
Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 5 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.(sm)
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $293,200 to $324,800. The salary range for Connecticut/Nevada residents is $293,200 to $324,800. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.
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.