Senior Medical Director of Clinical Program Governance and Standardization - Remote

UnitedHealth Group•Tampa, FL

23d•$292,300 - $438,500•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 UHC Senior Medical Director of Clinical Program Governance & Standardization is part of the UCS Clinical Evidence Group. This physician is responsible for supporting and driving key clinical program governance, clinical standardization, and clinical evidence alignment processes in close collaboration with the National CMO of the UCS Clinical Evidence Group. The portfolio of efforts for which the incumbent will provide support, oversight, and leadership includes: The UHC Clinical Program Governance process which is charged with ensuring deployed clinical programs are clinically sound, effective, carefully monitored, and advance enterprise goals. The core process (Clinical Program Review (CPR)) evaluates ~50 clinical programs annually for program performance and design as well as alignment our member and health plan needs. The process aims to optimize our clinical program investments, ensuring that the portfolio reflects our best opportunity to improve health, enhance experience, and reduce unwarranted spending. The CPR governance effort also includes: 1. support of early program development through the clinical program Ideation Front Door (IFD) process and, 2. Clinical review of vendor candidates for the UHC & Optum Hub and Store (~40/year) UHC’s participation in cross industry effort to advance standards and reduce friction for members and providers. This work is currently most intensely focused on ensuring UHC achieves its clinical standardization commitment to AHIP. The work involves collaborating with competitor teams and legal oversight teams to reduce friction-generating differences in UM processes across the industry The incumbent will report to the National CMO of the Clinical Evidence Group. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Requirements

Masters level degree (or higher) in statistics, epidemiology, health services research or a related field
Board certified physician in an ABMS/AOBMS Specialty
Active/unrestricted U.S. Medical Licensure
5+ years of experience as a clinician (MD, DO or equivalent)
3+ years of experience in health plan administration, health services research, quality assurance or comparable experience
3+ years serving as a consultant or leading a team on point for care quality improvement or product development and production
Deep understanding of health plan medical policies, utilization management processes, and interpretation of data-rich reports related to utilization management programs
Proficient in Excel, PowerPoint, Teams, Outlook and SharePoint
Demonstrated ability to understand and efficiently interpret expansive data on clinical performance, program ID Strat (inclusion & exclusion criteria), financial impact data as well as program auditing and compliance review results
Demonstrated ability to work collaboratively with clinicians, administrators and customers
Demonstrated ability to drive process standardizations without suppressing creativity
Demonstrated ability to navigate complex conversations with external partners, customers and providers who may challenge product specifications or analytic methods
Demonstrated flexibility, agility and the ability to adapt to change while staying organized and maintaining solid relationships

Nice To Haves

Experience with clinical program design, deployment and/or evaluation in the provider or payer setting
Experience interacting with leaders across diverse members of the healthcare industry

Responsibilities

Bring a seasoned clinical lens to the review of clinical programs to ensure the clinical model is evidence-based and optimized for impact and experience
Review program performance measurement in advance of committee meetings to ensure reports are clear, complete, up to date, and transparent. These include HCE impact assessments on financial impact
Work with CPR Committee Chair, Director, team and stakeholders to maintain a disciplined processes for operation, documentation, and communication
Manage the CPR team of 3-5 people under the Director, charged with operating the Ideation Front Door process, the Clinical Discovery Forum and the Clinical Program Review in close collaboration with program owners, health plan leaders and Healthcare economics teams
Ensure that the team follows up with clinical program owners and operations teams regularly to ensure CPR recommendations are implemented (or understand why not)
Participate in cross-industry team meetings and contribute UHC’s perspective to support efficient advancement of standardization efforts, under the oversight of our UHC and UHG legal partners
Develop, review and refine standardization documents, consulting regularly with UHC SMEs to ensure that our contribution fully reflects our perspective and that internal team leaders have an opportunity to weigh in when appropriate