1+ months

C&S Sr. Clinical Medical Director - Virtual - 891508

Houston, TX 77002
  • Job Code
    891508

PURPOSE OF JOB:

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The Sr. Clinical Medical Director will report to the CMO of"UnitedHealthcare C&S and is a key member of the Leadership Team. On"behalf of the CMO for C&S, this Sr. Clinical Medical Director will serve as"the primary mentor and leader for our C&S CMOs in each market, and address"core clinical regulatory and compliance issues in local markets. The Sr. Clinical Medical Director will work with"each C&S market CMO to develop and execute clinical strategies to improve"our compliance, quality and affordability strategies across all our markets,"working closely with our UCS shared services clinical partners.

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The position will have joint accountability with the C&S CMO for compliance"in each market for clinical oversight of our membership, clinical product"offerings, clinical market strategies, clinical support for RFPs, collaboration"and engagement with our Shared Services clinical team particularly around"Clinical Continuum efforts in each market,"new clinical program implementations, monitoring and valuing clinical"outcomes and operational performance, driving affordability pipeline and"performance, overseeing development and implementation of initiatives to meet"Quality standards, ensuring compliance with Medicare and state Medicaid"compliance standards and appropriate capital stewardship.

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This critical leadership role will also act as the liaison for critical"clinical initiatives and will collaborate across the clinical organization"partnering with Optum, ECS, and UCS to design and deliver on the C&S"clinical outcomes such as Clinical Continuum, prior authorization policies, and"inpatient care management efforts. This"role will work in a highly matrix organization and be responsible for impacting"results and change without direct authority."As the primary liaison on these critical affordability and quality initiatives"across the enterprise, this role will be accountable for the success of these"enterprise-wide initiatives that impact the C&S clinical strategy.,

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This role will be responsible for having exceptional knowledge of"Medicaid in order to understand the impact of their decisions on the desired"clinical outcomes as well as strong experience in the United Health Group"environment.

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RESPONSIBILITIES:

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"Mentor and support our market level CMOs - Principal mentor and support for our"market level CMOs, including recruitment, training, and ongoing mentorship and"support.

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o Goals"

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"Recruit"CMOs-work with C&S market CEOs, the C&S CMO, and Human Capital partners"to identify and recruit CMOs to address the specific challenges unique to each"market.

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"Train and"onboard CMOs-while each market level CMO will report to the C&S market CEO,"this role will actively support their training and onboarding.

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"Support and"mentor CMOs-this role will directly mentor the market C&S CMOs as providing"ongoing support for each market CMO to be successful in their initiatives.

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"Ensure"connection of the market CMOs to the larger UHG organization, particularly our"Optum and UCS Shared Services partners.

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"Periodic"review of the training and mentorship program to ensure effectiveness

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"Own Market Strategies to meet the Needs of"Customers -"End-to-end owner of the clinical product offerings for Community & State."Own and continuously improve / update the clinical model for all programs for"competitiveness, compliance, efficiency, and affordability.

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o Goals"

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"Develop"clinical model for all products. Provide"strategic clinical leadership of medical staff and programs throughout"C&S. Align with shared services"capabilities as much as practical and consistent with state mandates.

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"DSNP

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"Medicaid"TANF

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"Medicaid"ABD/SSI

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"Medicaid LTC

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"MME

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"Special programs"- CRS, DD, etc.

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"Quarterly"deep dive review of clinical programs with shared services and delegates to"assure clinical model effectiveness.

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"Ongoing"monitoring through agreed upon metrics.

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"Ensure"continuously developing efficiencies in delivering clinical model by shared"services and delegates.

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"Design and Execute Programs Jointly with"Shared Service Teams - Provide"clinical program requirements to Shared Service Teams. Participate in design and production"oversight to efficiently and effectively deliver high quality clinical product"offerings. Partner to oversee and"execute these core affordability and quality strategies, with accountability"for delivering on results from these initiatives.

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o Goals

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"Work with shared"services teams in connection with each market CMO to improve our efforts on"Clinical Continuum, prior authorization, and inpatient care management, in"order to identify and address areas of opportunity in each market and execute"on initiatives to address these areas of opportunity.

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"Do above by"engaging with shared service teams and development.

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"Provide"requirements and oversee program development and deployment.

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"On a"periodic basis, report progress towards affordability and quality targets along"with our shared service partners and describe pathways for improvement.

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"Support RFP Process through Superior Clinical"Product Design - Monitor"RFPs for emerging requirements and develop product offerings that will"satisfy/delight regulators and members. Work with Development to understand"competitor offerings and counter with competitive and superior programs. Develop a roadmap/pipeline of product"offerings. Directly support the RFP"process through understanding and explaining existing and new clinical programs"in a way that the writers can effectively and interestingly present them.

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o Goals

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"Get ahead of"RFP process with design sessions for clinical programs. Monitor RFP requirements through working with"the development organization and clinical shared services and delegates.

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"Develop a"pipeline of programs to meet emerging RFP requirements and competitor"offerings. Bring Development into"discussion around changing and evolving clinical programs requirements.

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"Lead efforts"to develop more market-based provider-based models and community-based models"to address social determinants of health.

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"Develop"off-the-shelf programs, in collaboration with network, product and clinical"shared services, for deployment to new RFPs.

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"Health and"Wellness

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"Member"incentive programs

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"Provider"incentive programs

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"Medical"Home/Accountable Care Communities

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"Disease/Condition"management

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"Translate"existing and new clinical programs for RFP writers. Assist in developing accurate descriptions.

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"Develop and"maintain up-to-date library of clinical responses.

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"Oversee Implementation of New Programs - Support new programs / health plan"implementation through support for hiring, training, and coordination of shared"services and delegates.

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o Goals

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"Provide"pre-implementation support for clinical program deployment including coordination"of health plan and clinical resources and readiness review.

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"Provide"on-site implementation support and command center participation.

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"Provide"post-implementation support to ensure full program implementation and"compliance.

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"Monitor Value and Performance - Regularly evaluate program outcomes,"quality, affordability, and operational results with shared set of metrics and"hold shared services teams accountable."Ensure that program outcomes are available to support RFP process and"demonstrate value proposition.

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o Goals

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"Establish"process and metrics to continuously monitor program performance, outcomes, and"ROI.

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"Use results"to continuously improve program offerings.

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"Retool or"replace ineffective programs.

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"Design/make"available outcome studies to support RFP process.

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"Affordability - Ensure total end-to-end affordability"through understanding of trend and addressing value drivers. Meet affordability commitments through Shared"Services and delegates and assuring health plan implementation of network and"local initiatives. Prospect within UHC"for affordability programs not yet fully implemented within C&S. Monitor the industry for emerging"affordability plays. Develop pipeline of"affordability initiatives.

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o Goals

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"Establish"affordability targets.

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"Ensure that"shared services and delegates appropriately understand their accountability and"have plans in place to meet/exceed targets.

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"Continuously"evaluate trend and address key drivers.

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"Achieve"targeted saving for bed days, prior auth, radiology, pharmacy, emergency room.

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"Continuously"monitor progress toward goals and adjust as necessary.

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"Participate"with network and operations to achieve targeted savings on UCRT, recoveries,"and Fraud and Abuse.

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"Develop"pipeline of initiatives by participating in development across the business,"mining playbooks, evaluating existing UHC programs not currently deployed to"C&S, evaluating competitor strategies and behaviors.

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"Quality Performance - Ensure services are delivered to members"at the highest quality standards."Oversee and ensure development and implementation of initiatives to meet"HEDIS quality standards, state bonus benchmarks, and Stars benchmarks for"pay-for-performance through working with and holding Quality Shared Services"accountable. Proceed toward goal of achieving"and maintaining full program NCQA accreditation. Continuously improve CAHPS scores for members"and providers.

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"Compliance - Oversee and ensure compliance with Medicare and state Medicaid"compliance standards around prior auth, utilization review, and appeals and"grievances through working with and holding accountable compliance, Clinical"Services, Optum, and other clinical delegates."Lead delegate oversight committees.

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"Capital Stewardship - Ensure deployment of capital to clinical"programs to maximize returns on compliance, affordability, quality, and"efficiency.

QUALIFICATIONS:


*"Bachelor's degree medical degree required
*"10+ years progressive, high impact, management experience
*"Have held a substantial leadership position in a managed care company, public program or organization serving government entities
*"Appreciation for the individuals served by state and public healthcare programs
*"Ability to successfully work in a matrix management environment, with a proven track record of building and maintaining effective internal partnerships that lead to external client satisfaction
*"Exceptional Relationship skills. Proven ability to quickly build and maintain strong relationships across diverse functions and leaders.
*"Strong strategic thinking and business acumen with the ability to align strategies and recommendations with clinical operations objectives. Adaptable and flexible style of collaborating with key stakeholders in setting direction.
*"Proven ability to quickly gain credibility, influence and partner with business leaders and the clinical operations community.
*"Strong understanding of compliance related issues and understanding of state contractual obligations.
*"Strong attention to detail, particularly in taking large amounts of data and making decisions based on those details.
*"Strong financial acumen, with experience managing a profit-and-loss program or a significant non-profit budget.
*"Ability to lead and motivate people to achieve agreed-upon results, with a focus on driving disciplined, fact-based decisions and executing with discipline and urgency.
*"Ability to balance multiple accountabilities and organizational change.


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


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.

Categories

Posted: 2020-11-03 Expires: 2021-02-03

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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C&S Sr. Clinical Medical Director - Virtual - 891508

UnitedHealth Group
Houston, TX 77002

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