UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm)

The Community and State (C&S) Plan Chief Medical Officer (CMO) has accountability for United Healthcare and United Clinical Services initiatives focusing on delivering clinical excellence, quality ratings improvement, appropriate inpatient and outpatient covered-service utilization and health care affordability with the goal to be best in class. Chief Medical Officers are expected to help drive integrated health system transformation including working with facilities, provider groups, and provider organizations, assisting to address provider network engagement and issues, supporting mandated legal and contractual provisions, compliance, growth strategies and developing/leading focused improvement projects that are implemented and successfully managed to achieve goals.

This position reports to the local C&S Plan Chief Executive Officer. The C&S Plan Chief Medical Officer primary responsibilities are directed towards C&S plan activities as defined by the C&S plan CEO and collaborates with Enterprise Clinical Services (ECS) staff and other market and regional matrix partners to implement programs to support and meet market C&S, UHC and line of business goals.

If you are located within the State of Indiana, you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

• Quality + Affordability - The Plan Chief Medical Officer has primary responsibility and accountability for medical performance and targets for the local C&S plan(s) being overseen. local plan staff, and UCS as well as with the C&S and UHC national affordability team. Activities may include conducting Joint Operations Committee meetings with prioritized providers, in coordination with Network and ECS, contributing to and implementing programmatic and strategic decisions, data sharing with physicians and physician groups on quality and efficiency improvement opportunities, and implementing local Health Care Affordability Initiatives. The Chief Medical Officer will be engaged as a clinical lead for healthcare affordability initiatives at the local market and establishing a process for sharing data and completing peer to peer communications as required. They will support medical dental, pharmaceutical, and or social initiatives and quality programs as required to achieve the appropriate utilization, affordability, HEDIS and Star goals of the C&S Health Plan. The Chief Medical Officer is accountable for building and leaning into relationships with internal and external partners to meet or exceed market, regional and national requirements. They have contributing oversight responsibility of the C&S market peer review process. as defined by State regulator as well as participating in or leading the applicable committees such as the Provider Advisory Committee (PAC), Quality Management Committee (QMC) and the Utilization Management Committee (UMC). They will work with teams to direct all member care to in-network providers unless care cannot be provided in network and in state. In which case, they will work with the Provider teams to complete single case agreements for the highest quality and most cost-effective care.
• Clinical Excellence, Quality Standards and Service Performance - The C&S plan Chief Medical Officer oversees and contributes to HEDIS and CMS Stars process improvement and performance strategy, CAHPS and Net Promoter Score improvement strategies and supports necessary Health Plan accreditation activities. The plan Chief Medical Officer is required to help achieve or exceed all applicable HEDIS, Stars and local state performance targets and goals otherwise specified for the local C&S plan. The Chief Medical Officer should act as an improvement catalyst for all service and quality-related efforts, influence, participate and communicate to network providers or vendors on new focus and measure/process changes. The Chief Medical Officer supports all Clinical Quality initiatives and peer review processes including Quality of Care and Quality of Service (grievance) issues and is responsible for representing the local C&S plan at State-level Fair Hearings and performing plan-level member/provider grievance and appeals reviews, as necessary. The Chief Medical Officer will oversee the development and implementation of the Contractor’s disease management, case management, and care management programs; oversee the development of the Contractor’s clinical practice guidelines; review any potential quality of care problems; oversee the Contractor’s clinical management program and programs that address special needs populations and health screenings.
• Innovation and Focused Improvement - As Chief Medical Officer, a culture of innovation and continuous improvement identification is to be incorporated at all levels of work. They are expected to collaborate with peers and colleagues in efforts to transform the health system and exceed all regulatory expectations. Local responsibilities include driving/supporting delivery system transformation growth and performance improvement, target setting and monitoring, as well as ongoing leadership during monthly JOCs. Knowledge of payment reform and value-based contracting variants for C&S will be required. Secondary responsibilities will include, but are not limited to, other clinical practice transformation efforts, patient-centered medical and behavioral health homes, innovative vendor and provider-led care coordination programs, health disparity assessments and action planning, high-performance network development and consumer engagement.
• Growth, Equity, Inclusion and Diversity - The Chief Medical Officer will help deliver our clinical value proposition focused on quality, affordability, and service, in support of growth activities of the C&S Health Plan, consistent with our prevailing values and culture. The plan Chief Medical Officer reviews and edits policies, SOPs, communications materials as required and represents the voice of the market-based customer in program design. Chief Medical Officer contributes to any RFP/re-procurement activity in the state, as requested, delivering subject matter expertise and clinical perspectives. The Plan Chief Medical Officer actively promotes positive relations with State/local regulatory authorities and Medical Societies, where possible, will participate with partner organizations, health equity and disparity efforts such as the DE&I council, promote cultural competencies and other factors which holistically help the health plan better meet community and member needs.
• Relationship Equity and State Compliance - The Plan Chief Medical Officer maintains a strong 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. They participate as a Subject Matter Expert (SME) in reviewing work plans and in operational reviews and audits. They also are committed to being effectively and positively 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 Chief Medical Officer will work collaboratively in these activities with ongoing ECS and C&S initiatives under the direction of the Plan CEO, C&S National CMO and/or the C&S Regional CMO. The Plan Chief Medical Officer will be called upon to support outward facing relationships to State regulators based upon contract, Plan CEO and C&S CMO and should provide clinical thought leadership with external entities and the state. The Chief Medical Officer, in close coordination with other key staff, is responsible for ensuring that the medical management and quality management components of the Contractor’s operations are compliant with the terms of the State Contract. The Chief Medical Officer shall work closely with the Pharmacy Director to ensure compliance with pharmacy-related responsibilities The Medical Director shall attend all FSSA quality meetings, including the Quality Strategy Committee meetings and Subcommittee meetings.
  

Skills, Experiences, Qualifications

• Ability to support and contribute to a team that values organizational and Plan success over personal success; provide ongoing coaching and feedback with colleagues and other team members to ensure peak performance; identify and invest in high-potentials; actively manage underperformance.
• Focus staff on the company's mission and values; 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.
• Demonstrate pro-active, solution-oriented approaches to work efforts and 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. Chief Medical Officers are a leadership position within the health plan, key contributors to the “C” Suite level team, a skilled General Manager with a clinical expertise.
• Drive change and innovation though continually seeking and implementing novel 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 with all company policies, and local, state, and federal regulations
• 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 exhibiting the culture of United Health Group.
  

Leadership Expectations:

• 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.
  

Indiana C&S Qualifications:

• Understanding of Medicaid, Dual Special Needs Plans (DSNP) and Medicare/Medicaid integration
• Clinical, professional interest in special needs populations and fully integrated healthcare models
• Willingness to travel locally, in Indiana, to communities where clinical and community partnerships require face to face interactions
  

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.

Required Qualifications:

• Indiana active/unrestricted Licensed Physician; must reside in the State of Indiana
• Active Board Certification in an ABMS/AOBMS Specialty
• Active Indiana-licensed Indiana Health Care Provider (IHCP) provider board certified in geriatrics, family medicine, or internal medicine
• 5+ years clinical practice experience; strong knowledge of managed care industry and the Medicaid line of business.
• 2+ years Quality management or Utilization Management experience
• Familiarity with current medical issues and practices
• Solid leadership skills, as demonstrated by continuously improved results, team building, and effectiveness in a highly matrixed organization
• Demonstrative presentation skills for both clinical and non-clinical audiences
• Proven ability to develop relationships with network and community physicians and other providers
• Solid data analysis and interpretation skills; ability to focus on key metrics
• Proficiency with Microsoft Office applications
• 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.
  

Preferred Qualifications:

• 10+ years of experience in clinical practice with older adults
• 2+ years of experience in Long Term Services and Supports (LTSS)
• Strategic thinking with proven ability to communicate a vision and drive results
• Solid negotiation and conflict management skills
• Solid team player and team building skills
• Excellent interpersonal communication skills
• Excellent project management skills
• Creative problem-solving skills
  

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 at UnitedHealthcare Community & State . Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.(sm)

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Colorado Residents Only: The salary range for Colorado 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.