UnitedHealthcare - Chief Medical Officer - Community & State

UnitedHealth Group•Minnetonka, MN

13h•$225,000 - $375,000•Remote

About The Position

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together. The Chief Medical Officer (CMO), Medicaid (Community & State), is the senior clinical executive accountable for enterprise clinical strategy, medical oversight and performance outcomes across the Medicaid portfolio. The CMO reports directly to the Chief Clinical Officer of United Clinical Services (UCS) and has a dotted line (indirect) reporting relationship to the CEO of Community & State. The CMO sets the clinical vision, drives measurable improvement in quality, equity, access and affordability, and ensures disciplined execution through a national, matrixed organization spanning health plans, shared services and Optum partners. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. Hybrid in MN/DC: This position follows a hybrid schedule with four in-office days per week.

Requirements

Active, unrestricted medical license; board certification in an ABMS or AOBMS specialty
12+ years of clinical practice experience; solid knowledge of the managed care industry
8+ years in a significant leadership role within a large clinical organization, payer or public-sector health program
5+ years experience in managed Medicaid
Demonstrated executive presence, interpersonal effectiveness and ability to influence senior leaders and external stakeholders
Solid written, verbal and presentation skills for clinical and non-clinical audiences
Solid data analysis and interpretation skills with a focus on key performance metrics
Proven ability to build relationships with network and community physicians and provider organizations
Strategic thinking with a track record of communicating a vision and driving results
Experience leading clinical strategy within Medicaid managed care, Medicare managed care and/or alternative payment models
Demonstrated experience partnering with state Medicaid agencies, CMS and other regulators
All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

Nice To Haves

Executive leadership experience within a Medicaid payer, state Medicaid agency, health system or large physician organization; proven ability to set clinical strategy and deliver measurable results
Influence-based leadership in complex, matrixed environments; ability to align diverse stakeholders, clarify decision rights and drive enterprise execution
Strong performance management orientation uses analytics, benchmarks and operating mechanisms to ensure accountability and continuous improvement
Credible external presence with ability to build trusted relationships with providers, community partners, regulators and policymakers
High integrity and sound clinical judgment; demonstrated commitment to compliance, program integrity and ethical decision-making
Executive communication skills, including the ability to translate clinical strategy into clear, compelling narratives for C-suite, regulators and external audiences

Responsibilities

In collaboration with the Community & State leadership team, drives the end-to-end clinical strategy and Medicaid clinical model across Community & State, ensuring competitiveness, compliance, operational efficiency and affordability; establishes governance and a disciplined operating cadence across markets and shared services
Use data-driven insight to identify opportunity areas; design and scale evidence-based clinical programs; collaborate with UCS clinical leaders and Clinical Program Review (CPR) to define KPIs and outcomes measures; conduct regular deep dives to enhance high-performing programs and redesign/retire those that do not meet expectations. Ensure programs leverage common clinical data model whenever possible to enable consistent analysis, modeling and trend prediction at an enterprise level
Partner with Healthcare Economics and UCS to set affordability targets; understand medical/pharmacy trend drivers; build and govern a pipeline of affordability initiatives; monitor progress and adjust strategies to achieve commitments. Maintain an active initiative pipeline, and hold markets, shared services and delegates accountable for results
Partner with market CEOs and CMOs, UnitedHealthcare Networks and business leaders to adapt strategy to state requirements and local delivery models; support the evolution toward more integrated, value-based and incented models of care
Drives initiatives to meet or exceed state and federal performance requirements, including HEDIS® and CAHPS® measures and applicable accreditation standards; drive measurable improvement in quality, equity, access and experience
In partnership with the Community & State CEO, Legal and Regulatory Affairs, develop and execute proactive advocacy and relationship strategies with CMS, state Medicaid leadership and policymakers
Provide executive oversight to ensure clinically sound and compliant medical policies, clinical benefits, utilization management and appeals and grievance practices across delegated and shared-service partners. Ensure all state-specific benefit designs, quality metrics and UM criteria are incorporated into clinical programs
Support Medicaid procurement and growth by articulating the clinical model, value proposition and outcomes; inform solution design to meet regulator, provider and member expectations
Supports and provides recommendation on investments in clinical capabilities to maximize impact across compliance, affordability, quality and operational efficiency; represent Community & State in external forums aligned to Medicaid clinical priorities