1+ months

UnitedHealthcare Market Chief Medical Officer Medicare and Retirement - Arkansas and Tennessee Markets - 908403

Nashville, TN 37201
  • Job Code
    908403

UnitedHealthcare Market Chief Medical Officer

""

Medicare and Retirement

""

""

Role Overview

""

UnitedHealthcares market medical directors (also referenced as Market CMOs) serve as the local clinical executive for their line of business, with accountability for:

""
    ""
  • Achieving defined clinical outcomes, affordability goals and growth targets, in partnership with their health plan leadership team
  • ""
  • Provide clinical insight into market data and implementing tailored interventions to address clinical trends and opportunities for their state or region
  • ""
  • Serving as a central point of contact to and coordination with UnitedHealthcare and Optum national clinical and operational functions
  • ""
  • Actively engage and help drive performance with market-level quality, network and compliance teams
  • ""
  • Building and deepening relationships with area hospitals, physicians, and other health care providers
  • ""
  • Advocate for UnitedHealthcares clinical value story, evidence-based medical policies, and member health with government entities, professional and medical society chapters, employers, and as part of external communications and media relations
  • ""
  • Provides subject/specialty based clinical expertise and leadership to UCS and the enterprise, as needed
  • "
""

""

Primary Core Accountabilities

""
    ""
  • Clinical Affordability MMDs are responsible for achieving their assigned incremental savings goal and support the national savings target for the year. Driving savings is a two-pronged, data-driven approach of local response and national implementation, where MMDs lead targeted clinical inventions to address local market trends and needs, and support on-the-ground alignment with national utilization management programs. Inform and drive local and national affordability initiatives: MMDs are expected to apply healthcare economics insights and escalate local issues and trends.
  • "
""

""
    ""
  • Network / Provider Engagement The MMD serves as the local clinical point of contact for physicians, systems and other care providers and with UnitedHealth Networks colleagues. Key activities include UHCs Accountable Care Platform, value-based contracting, clinical practice transformation, patient-centered medical homes, and transparency initiatives such as UnitedHealth Premium Designation and/or High Performing Physicians. The MMD meets regularly with hospitals and physician groups and shares data on quality and efficiency improvement opportunities and developing action plans for sub-optimal results.
  • "
""

""
    ""
  • Market Relationships The MMD is the clinical face of UnitedHealthcare to elected officials, policy makers, plan sponsors, medical and professional societies, news media, and community-based organizations. The MMD is engaged in regular, proactive dialogue with our external constituents to advance evidence-based medicine and support best practices in health care delivery.
  • "
""

""
    ""
  • Quality & Compliance The MMD maintains a strong working knowledge of all government mandates and provisions, working across the enterprise to implement and maintain compliant clinical programs and procedures. The MMD also supports quality improvement efforts as measured by CMS Star Ratings, NCQA Star Ratings, HEDIS, CAHPS, HOS and other national and company metrics. The MMD partners with UHC Compliance to ensure clinical management regulatory obligations regarding clinical management are met. Market CMOs also chair required Quality Oversight Committees at a market/regional level.
  • "
""

""

Market Chief Medical Officer

""

Line of Business Addendum Medicare & Retirement

""

""

Role Overview See universal job description for full details.

""

""

Primary Core Responsibilities See universal job description for full details.

""
    ""
  • Clinical Affordability
  • ""
  • Network Development
  • ""
  • Constituent Relationships
  • ""
  • Quality & Compliance
  • "
""

""

Job Responsibilities

""
    ""
  • The MMD for Medicare & Retirement reports to the Regional CMO in UCS.
  • "
""

""
    ""
  • Drives population health management, Stars, ADDC and HouseCalls engagement through clinical support for ACOs and QFO, value-based contracting/performance and network support.
  • "
""

""
    ""
  • Drives revenue in partnership with market leadership via impact on STARs ratings, CAHPS and HOS performance.
  • "
""

""
    ""
  • Drives National M&R clinical programs at market level; develop, implement, and drive market-specific affordability programs. Examples include driving adoption of preferred HH and SNF provider list with Hospitals and providers, Vivify direct referrals from CMO and developing ACO specific affordability targets at market ACO level. Local affordability includes developing local palliative care options when national vender not an option and working with local providers to drive care at home options.
  • "
""

""
    ""
  • Pharmacist lead programs are primarily Stars focused and augmented by the market CMO. Peer to Peer discussions include Med rec post discharge leads to decreased readmission, Medication adherence leads to decreased admissions and overall cost of care and Statin usage in CAD and DM
  • "
""

""
    ""
  • Maintains a strong working knowledge of all CMS mandates and provisions for the local M&R market, as well as delegation oversight, quality of care and peer reviews. Informs market teams and local providers of any changes; local delegates compliance with CMS/UHC; Reviews complains and determines best action for quality of care issues.
  • "
"

Required Qualifications:

""
    ""
  • Active and unrestricted medical license for the assigned market(s)
  • ""
  • Current board certification
  • ""
  • 5+ years clinical practice experience
  • ""
  • Strong knowledge of managed care industry
  • "
""
    ""
  • Familiarity with current medical issues and practices
  • ""
  • Excellent interpersonal communication skills; ability to influence in executive settings
  • ""
  • Strong knowledge of health care utilization data and analytics
  • ""
  • Proven ability to identify an improvement opportunity through data, implement a solution and achieve measurable impact. Solid data analysis and interpretation skills; Metrics driven.
  • ""
  • Ability/experience in developing collaborative relationships with health system clinical leadership
  • ""
  • Superior presentation skills for both clinical and non-clinical audiences
  • "
""
    ""
  • Proven ability to develop relationships with network and community physicians and other providers
  • ""
  • Ability to travel within the assigned market
  • ""
  • Proficiency with Microsoft Office applications (Outlook, Word, Excel, PowerPoint)
  • ""
  • Capable to quickly become facile with UHC/UHG specific data systems
  • "
""

""

Preferred Qualifications:

""
    ""
  • Prior health plan experience
  • ""
  • Advanced Business, Public Health, Medical Management degree
  • "
""
    ""
  • Strong team player and team building skills
  • ""
  • Strategic thinking with proven ability to communicate a vision and drive results
  • ""
  • Solid negotiation and conflict management skills
  • ""
  • Creative problem-solving skills
  • "
""

""

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can 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: 2021-02-15 Expires: 2021-05-14

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.

Before you go...

Our free job seeker tools include alerts for new jobs, saving your favorites, optimized job matching, and more! Just enter your email below.

Share this job:

UnitedHealthcare Market Chief Medical Officer Medicare and Retirement - Arkansas and Tennessee Markets - 908403

UnitedHealth Group
Nashville, TN 37201

Join us to start saving your Favorite Jobs!

Sign In Create Account
Powered ByCareerCast