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Market Chief Medical Officer Medicare & Retirement - New England - Massachusetts Based - Virtual

Company: UnitedHealth Group
Location: Quincy
Posted on: November 22, 2022

Job Description:

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 Market Chief Medical Officer (CMO) is the senior clinical executive for the designated market plans for Medicare & Retirement (M&R). The CMO has accountability for driving excellent results for all clinical affordability, quality, population health, growth, Net Promoter Score (NPS), and external relationship initiatives for the designated market.

The CMO is the leader of the market ensuring integration of all United Healthcare (UHC), United Clinical Services (UCS) and OPTUM clinical functions to drive incremental reduction in admissions/ readmissions, continuous improvement of HEDIS and STARs ratings, reduction of unnecessary ER visits, and mitigation of provider abrasion from prior authorization and inpatient management programs.

The CMO collaborates with the market CEO, the market Senior Leadership (SLT) team, UCS staff, and matrix partners such as Network, Sales and other market and regional partners to implement and drive programs to support and meet UCS goals for commercial and Medicare lines of business. The CMO reports to the Regional Chief Medical Officer with dotted line accountability to the local market CEO.

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

Primary Responsibilities:

  • Quality and Affordability - The CMO has responsibilities for utilization management from a macro view: conducting hospital Joint Operations Committee meetings, contributing to and implementing regional Medical Cost Operating Team decisions, bed day action committee meetings with Inpatient Care Management (ICM), data sharing with physicians and physician groups on quality and efficiency improvement opportunities, and implementing local Health Care Affordability Initiatives. At a more micro level, the CMO will drive and manage Market ACO and delegated medical group performance and work with providers to close clinical quality gaps in care for STARs and HEDIS. This focus not only ensures affordability gains but also drives and reinforces the importance of the triple aim with strong emphasis on value realization at the market level
  • Clinical Excellence - The CMO helps oversee the HEDIS data collection process, CAHPS improvement as the measure of member satisfaction and quality in its broadest definition (QoC, HEDIS, QIPs), and drive Health Plan accreditation activities as well as quality rating initiatives. The CMO acts as an improvement catalyst for all quality-related efforts including CMS Star initiatives. Additionally, the CMO communicates with providers on new focus and measure/process changes and supports all Clinical Quality initiatives and peer review processes including Quality of Care and Quality of Service issues
  • Relationship Equity - The CMO maintains a strong working knowledge of all government mandates and provisions, working across the enterprise to implement and maintain compliant clinical programs and procedures. S/he is engaged in regular, proactive dialogue with our external constituents), to continuously improve health care to enrollees and better products for our customers
  • Innovation - This CMO leads the clinical interface with care providers and UHC network management colleagues in efforts to transform the health system, including, but not limited to, UHC's Accountable Care Platform, value-based contracting, clinical practice transformation, patient-centered medical homes, transparency initiatives such as UnitedHealth Premium Designation, creative care management programs, high-performance networks, consumer engagement, and value-based benefit designs
  • Growth - This CMO delivers the clinical value proposition focused on quality, affordability, and service, in support of the sales and growth activities of the Health Plan including conducting Broker/Client presentations and participating in customer consultations. The CMO reviews and edits communications materials as required and represents the voice of the market-based customer in program design. S/he actively promotes positive relations with State/local regulatory authorities and Medical Societies
  • Focused Improvement - The CMO is responsible for identifying opportunities through participation in regional and local Medical Cost Operating Teams or Market reviews. Additional responsibilities include the timely collection and entry of information into Online Engagement Survey tools and scorecards; developing action plans for sub-optimal results; and taking a leadership role in United Clinical Services and Quality Affordability Programs initiativesYou'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:
    • Active and unrestricted medical license in Massachusetts
    • Active and unrestricted Board Certification in an ABMS or AOBMS specialty
    • 5+ years clinical practice experience; strong knowledge of managed care industry
    • Ability/experience in developing collaborative relationships with health system clinical leadership
    • Familiarity with current medical issues and practices
    • Knowledge of health plan finance, STARs, and accurate coding helpful, but not require
    • Solid knowledge of health care utilization data and analytics
    • Solid data analysis and interpretation skills; ability to focus on key metrics
    • Solid negotiation and conflict management skills
    • Proficiency with Microsoft Office applications (Outlook, Word, Excel, PowerPoint)
    • Works in partnership with the CEO to achieve financial and quality (STARs) goals
    • Superior presentation skills for both clinical and non-clinical audiences
    • Excellent interpersonal communication skills and ability to influence in executive settings
    • Ability to identify an improvement opportunity through data, implement a solution and achieve measurable impact. Metrics driven
    • Ability to develop relationships with network and community physicians and other providers
    • Ability to travel within the assigned market
    • 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:
      • Advanced Business, Public Health, Medical Management degree
      • Health plan experience
      • Strategic thinking with proven ability to communicate a vision and drive results
      • Creative problem-solving skills
      • Solid team orientation, willing to roll up their sleeves and work with all levels within the organization. Can get things done within a matrixed environment and isn't hung up on who reports to who
      • Solid team player and team building skills Demonstrable Skills and Experiences:
        • Proven record of executive leadership/clinical management in a hospital system or large practice group
        • Drive change and innovation though continually seeking and implementing innovative 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
        • Ability to build a team through influence that values organizational success over personal success; drive exceptional performance by provide ongoing coaching and feedback; identify and invest in high potentials; actively manage underperformance
        • Execute with discipline and urgency: 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
        • Model and demand integrity and compliance
        • 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 organizationTo 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 . click apply for full job details

Keywords: UnitedHealth Group, Quincy , Market Chief Medical Officer Medicare & Retirement - New England - Massachusetts Based - Virtual, Executive , Quincy, Massachusetts

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