Reporting to the CEO of UnitedHealthcare Medicare & Retirement (M&R), the Chief Medical Officer will be a member of the M&R Executive Team. The position has accountability for senior clinical liaison with the Center for Medicare and Medicaid Services, all clinical product offerings, clinical market strategies, clinical support for sales and growth opportunities, collaboration and engagement with our Shared Services clinical team, clinical data analysis to improve clinical and cost outcomes, new clinical program implementations, monitoring and valuing clinical outcomes and operational performance, driving affordability pipeline and performance, overseeing development and implementation of initiatives to meet Quality standards, ensuring Compliance with Medicare and state Medicaid compliance standardsâwCMOhere applicable, and appropriate capital stewardship.
- Own Market Strategies to meet the Needs of Customers – End-to-end owner of the clinical product offerings/clinical model for Medicare & Retirement. Own and continuously improve / update the clinical model for all programs for competitiveness, compliance, efficiency, and affordability.
- Support the annual Federal bid process through Superior Clinical Product Design – Monitor RFPs for emerging requirements and develop product offerings that will satisfy/delight regulators and members. Work with Development to understand competitor offerings and counter with competitive and superior programs. Develop a roadmap/pipeline of product offerings, including Health and Wellness, Preventive Health, Member incentive programs, Provider incentive programs, Medical Home/Accountable Care Communities, and Disease/Condition management
- Collaborate with M&R CEO and Legal, Regulatory Affairs â Actively engage with CEO and Legal and Regulatory Affairs in order to develop and implement proactive advocacy and relationship strategy with CMS leadership, program directors, and other policymakers.
- Design Programs Jointly with Shared Service Teams â Provide clinical program requirements to Shared Service Teams. Participate in design and production oversight to efficiently and effectively deliver high quality clinical product offerings
- Support RFP Process as Clinical SMEs â Directly support the RFP process through understanding and explaining existing and new clinical programs to enable RFP writers to write and present information both effectively and interestingly
- Oversee Implementation of New Programs â Support new programs / health plan implementation through support for hiring, training, and coordination of shared services and delegates
- Monitor Value and Performance â Regularly evaluate program outcomes, quality, affordability, and operational results with shared set of metrics and hold shared services teams accountable. Ensure that program outcomes are available to support RFP process and demonstrate value proposition
- Affordability â Ensure total end-to-end affordability through understanding of trend and addressing value drivers. Meet affordability commitments through Shared Services and delegates and assuring health plan implementation of network and local initiatives. Prospect within UHC for affordability programs not yet fully implemented within C&S. Monitor the industry for emerging affordability plays. Develop pipeline of affordability initiatives by participating in development across the business, mining playbooks, evaluating existing UHC programs not currently deployed to C&S, and evaluating competitor strategies and behaviors.
- Quality Performance â Ensure services are delivered to members at the highest quality standards. Oversee and ensure development and implementation of initiatives to meet or exceed STAR ratings at bonus-level thresholds, HEDIS quality standards, and accreditation standards through working with and holding Quality Shared Services accountable. Continuously improve STAR, HEDIS, and CAHPS scores for members and providers.
- Compliance â Oversee and ensure compliance with Medicare compliance standards around prior authorization, utilization review, and appeals and grievances through working with and holding accountable compliance, Clinical Services, Optum, and other clinical delegates
- Capital Stewardship â Ensure deployment of capital to clinical programs to maximize returns on compliance, affordability, quality, and efficiency.
- Current and non-restricted licensed physician
- Board Certified in ABMS specialty
- 5+ years post-licensure experience as a senior clinician and leader with responsibility for clinical standards, quality management, and clinical supervision in a health plan organization.
- 5+ years experience in Medicaid/Medicare government programs or Medicare fee for services highly preferred.
- 5+ years previous in managed care
- Demonstrated accomplishments in the areas of medical care delivery
- Strong operational focus with demonstrated data analysis / interpretation acumen, project management, change management, and execution skills.
- Experience in population health management
- Self-motivated and able to work with little direct supervision and drive results with disciplined follow-though.
- Strong strategic thinking and business acumen with the ability to align clinical related strategies and recommendations with business objectives.
- Adaptable and flexible style of collaborating with key stakeholders in setting direction.
- Proven ability to quickly gain credibility, influence and partner with employees, business leaders and the clinical community
- High integrity with a reputation of a trusted confidential advisor and partner.
- Visibility and involvement in medical community
- Ability to develop relationships with network and community physicians and other providers.
- Excellent presentation skills for both clinical and non-clinical audiences.
UnitedHealthcare Medicare & Retirement is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.
Imagine joining a group of professionals and clinicians who are working to improve health care for people over 50. Consider the influence you can have on the quality of care for millions of people. Now, enhance that success with enthusiasm you can really feel.
That's how it is at UnitedHealthcare Medicare & Retirement. Everyday, we're collaborating to improve the health and well being of the fastest growing segment of our nation's population. And we're doing it with an intense amount of dedication.
Here, you will discover a culture that grows through challenge. That evolves by being flexible. That succeeds by staying true to our mission to make health care work effectively and efficiently for seniors. Put your best to work for us, and discover extraordinary opportunities for growth.
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UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.