UnitedHealthcare - Chief Medical Officer - Medicare & Retirement

UnitedHealth Group•Minnetonka, MN

13h•$225,000 - $375,000•Hybrid

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) of Medicare and Retirement (M&R) is the senior clinical executive accountable for enterprise clinical strategy, medical oversight and clinical performance outcomes across the Medicare Advantage portfolio. The CMO reports directly to the enterprise Chief Clinical Officer of United Clinical Services (UCS) and has an indirect reporting relationship to the CEO of Government Programs. The role leads data-driven clinical innovation and value creation—improving outcomes, affordability and member experience—while partnering closely with UnitedHealthcare Clinical Services (UCS), Healthcare Economics, Product, Operations, Networks and Optum clinical organizations. 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. Position Context & Scope Member of the Medicare & Retirement Executive Team and UnitedHealthcare Clinical Services (UCS) leadership team; represents M&R clinical priorities across the enterprise Oversees UCS M&R CMO leadership team Collaborates with the Medicare & Retirement leadership team to drive clinical performance and clinical policy Senior clinical liaison with the Centers for Medicare & Medicaid Services (CMS) and other regulators, supporting advocacy, product integrity and program performance Provide clinical expertise into the development of clinical product offerings and delegated clinical programs impacting Medicare Advantage membership, including quality (Stars/HEDIS/CAHPS), utilization management and affordability initiatives Leads clinical benchmarking, outcomes measurement and standardized performance reporting to ensure rigorous governance and continuous improvement Primary Responsibility Clinical strategy & product ownership: Collaborate with Medicare & Retirement leadership to develop the end-to-end Medicare Advantage clinical model and design clinically differentiated product offerings; continuously evolve program competitiveness, compliance, operational efficiency and affordability Program design, measurement & performance management: 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 consistent trend prediction at an enterprise level Quality leadership (Stars/HEDIS/CAHPS): Provides clinical guidance on initiatives to meet or exceed CMS Star Ratings thresholds, HEDIS® quality standards, CAHPS® measures and accreditation requirements; hold Quality Shared Services and clinical delegates accountable for results Affordability & trend management: 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 Network-aligned clinical execution: Partner with regional CMOs, UnitedHealthcare Networks (UHN), and market leaders to adapt clinical strategy to local dynamics (e.g., PPO/FFS vs. HMO/capitated markets) and drive quality, service and affordability performance Growth enablement & bid support: Support annual Medicare Advantage bid and product development processes through superior clinical benefit design; provide clinical insight on competitive positioning; develop outcome studies and performance evidence to support RFPs (Group membership) and growth opportunities Regulatory engagement & advocacy: In partnership with the M&R CEO, Legal and External Affairs, engage CMS leadership and policymakers to inform and advance proactive advocacy and relationship strategies. Work closely with UCS, legal and compliance to ensure thorough review and shared understanding of annual Final Rule requirements Compliance oversight: Ensure compliance with Medicare requirements for utilization management, prior authorization, appeals and grievances and clinical delegation through governance with Compliance, UCS, Optum and other partners Capital stewardship: Supports and provides recommendations on investment decisions for clinical programs to maximize returns across compliance, affordability, quality and operational effectiveness Key Partners & Stakeholders M&R CEO and executive team, market presidents and health plan leadership UnitedHealthcare Clinical Services (UCS) and clinical functional leaders (e.g., Star Ratings, Quality, Pharmacy, Utilization Management, Clinical Program Review.) Healthcare Economics and Finance (benchmarking, affordability targets, performance, objective evaluation of clinical program outcomes and ROI) Optum clinical organizations and delegated entities (program execution, outcomes/ROI accountability) UnitedHealthcare Networks (UHN), regional CMOs and market/field leadership (local clinical strategy and provider alignment) Product, Marketing, Sales and Bid teams (clinical benefit design, competitive positioning, RFP support) Legal, Regulatory Affairs and Compliance (CMS engagement, Medicare compliance, delegation governance) Executive Competencies Executive leadership experience within a payer, health system or large physician organization; ability to set clinical strategy and deliver measurable results Change leadership and innovation mindset: challenges legacy approaches, takes well-reasoned risk and builds a culture of continuous improvement Influence-based leadership in complex matrix environments; proven ability to align stakeholders and eliminate redundancy/overlap across functions Disciplined operating cadence with strong execution, metric-driven performance management and financial stewardship High integrity with a demonstrated commitment to compliance and ethical decision-making Solid external presence with the ability to build trusted relationships with network and community physicians, provider organizations and clinical leaders Executive communication and presentation capability for both clinical and non-clinical audiences 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.

Requirements

Active, unrestricted medical license (aligned to assigned market needs); board certification in an ABMS or AOBMS specialty
12+ years of clinical practice experience; strong knowledge of the managed care industry
12+ years of Medicare Advantage experience and/or demonstrated expertise in CMS policy and alternative payment models
8+ years in a significant leadership role within a large clinical organization or payer
5+ years of experience in a Medicare Advantage health plan
Demonstrated executive presence, interpersonal effectiveness and ability to influence senior leaders
Solid data analysis and interpretation skills with focus on key performance metrics
Proven relationship-building capability with provider networks and community physicians

Nice To Haves

Advanced degree in business, public health, medical management or related field

Responsibilities

Oversees UCS M&R CMO leadership team
Collaborates with the Medicare & Retirement leadership team to drive clinical performance and clinical policy
Senior clinical liaison with the Centers for Medicare & Medicaid Services (CMS) and other regulators, supporting advocacy, product integrity and program performance
Provide clinical expertise into the development of clinical product offerings and delegated clinical programs impacting Medicare Advantage membership, including quality (Stars/HEDIS/CAHPS), utilization management and affordability initiatives
Leads clinical benchmarking, outcomes measurement and standardized performance reporting to ensure rigorous governance and continuous improvement
Collaborate with Medicare & Retirement leadership to develop the end-to-end Medicare Advantage clinical model and design clinically differentiated product offerings; continuously evolve program competitiveness, compliance, operational efficiency and affordability
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 consistent trend prediction at an enterprise level
Provides clinical guidance on initiatives to meet or exceed CMS Star Ratings thresholds, HEDIS® quality standards, CAHPS® measures and accreditation requirements; hold Quality Shared Services and clinical delegates accountable for results
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 regional CMOs, UnitedHealthcare Networks (UHN), and market leaders to adapt clinical strategy to local dynamics (e.g., PPO/FFS vs. HMO/capitated markets) and drive quality, service and affordability performance
Support annual Medicare Advantage bid and product development processes through superior clinical benefit design; provide clinical insight on competitive positioning; develop outcome studies and performance evidence to support RFPs (Group membership) and growth opportunities
In partnership with the M&R CEO, Legal and External Affairs, engage CMS leadership and policymakers to inform and advance proactive advocacy and relationship strategies. Work closely with UCS, legal and compliance to ensure thorough review and shared understanding of annual Final Rule requirements
Ensure compliance with Medicare requirements for utilization management, prior authorization, appeals and grievances and clinical delegation through governance with Compliance, UCS, Optum and other partners
Supports and provides recommendations on investment decisions for clinical programs to maximize returns across compliance, affordability, quality and operational effectiveness