The C&S Plan Chief Medical Officer has accountability for ensuring that local health plan , United Clinical Services and UHC initiatives focusing on clinical excellence, quality ratings improvement, appropriate inpatient and outpatient utilization, health care affordability, health system transformation including provider network issues, mandated provisions and compliance, growth and focused improvement are implemented and successfully managed to achieve goals. This position reports to the local C&S plan President and has dotted line relationships to the C&S Chief Medical Officer and UCS market-assigned Regional Chief Medical Officer The C&S Plan CMO’s primary responsibilities are directed towards C&S plan activities as defined by the C&S plan CEO and also collaborates with United Clinical Services (UCS) staff including the regional Chief Medical Officer, and other market and regional matrix partners to implement programs to support and meet market C&S, UCS/ UHC and line of business goals. Primary Responsibilities:
- Quality and Affordability – The Plan CMO has primary responsibility and accountability for Total Medical PMPM performance and targets for the local C&S plan. This will require a close working relationship with UCS clinical operations teams as well as with the C&S and UCS national affordability team. Activities will include conducting hospital Joint Operations Committee meetings with Network, contributing to--and implementing--regional Medical Cost Operating Team (MCOT) decisions, data sharing with physicians and physician groups on quality and efficiency improvement opportunities, and implementing local Health Care Affordability Initiatives. The Medical director will serve as clinical lead for healthcare affordability initiatives at the local market and establishing a process for sharing data with hospitals and physicians and completing peer to peer communications as required. Additionally the Plan CMO has primary responsibility to oversee new clinical model operations including ACC Accountable Care Community relationships, Target setting JOC leadership. Support UHN initiatives and Quality Affordability Programs as required in order to achieve the appropriate inpatient and outpatient utilization and affordability goals of the C&S Health Plan and United Clinical Services/ UHC. The Plan CMO has oversight responsibility of the C&S market peer review process as defined by State regulator as well as participating in or leading the Peer Review committee.
- Clinical Excellence – The C&S plan CMO helps oversee the HEDIS data collection process, STARs clinical collection process, CAHPS improvement, and drive Health Plan accreditation activities as well as quality rating initiatives for the local CMS plan. The plan CMO is accountable for HEDIS and Stars performance for the Local C&S plan. This Medical director may also act in a similar capacity for Non C&S HEDIS, STARs as directed by UCS regional CMO. Acts as an improvement catalyst for all quality-related efforts including Center for Medicare and Medicaid Services Star initiatives. Communicate to providers on new focus and measure/process changes. Supports all Clinical Quality initiatives and peer review processes including Quality of Care and Quality of Service issues.
- Relationship Equity and State Compliance—The Plan CMO 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. S/he also is committed to being effectively 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 CMO will work collaboratively in these activities with ongoing UCS initiatives under the aegis of UCS Regional CMO. The Plan CMO will be the outward face to State regulators based upon Contract, and direction of Plan President and C&S CMO.
- Innovation—The Plan CMO leads the clinical interface with care providers and UHC network management colleagues in efforts to transform the health system. Primary local responsibility is to drive Accountable Care Community (ACC) growth through identification of appropriate practices; initial contact and target setting, and Implementation, as well as ongoing leadership of monthly JOCs. Knowledge of Value Based contracting variants for C&S will be essential Secondary responsibility will include but not limited to, UHC’s Accountable Care Platform, , clinical practice transformation, patient-centered medical homes, accountable care organizations, creative care management programs, high-performance networks and network optimization, consumer engagement, and
- Growth – This medical director delivers the clinical value proposition focused on quality, affordability and service, in support of growth activities of the C&S Health Plan and the plan CMO reviews and edits communications materials as required, and represents the voice of the market-based customer in program design. The Plan CMO actively promotes positive relations with State/local regulatory authorities and Medical Societies and records such in PEI tool
- Focused Improvement –The Plan CMO is responsible for identifying opportunities through participation in regional and local Medical Cost Operating Teams or Market reviews, National MCOT. S/he actively participates in Joint Operating Committees. S/he also provides local feedback on and oversight of the performance Optum Behavioral Solutions and OptumHealth as needed. 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 Quality Affordability Programs initiatives.
- Grievance and Appeals- the Plan CMO maintains an active liaison with UCS G&A, and is responsible for representing the Local C&S plan at State Fair Hearings.
- Ability to build a team that values organizational and Plan success over personal success; provide ongoing coaching and feedback to ensure peak performance; identify and invest in high-potentials; actively manage underperformance
- Focus staff on the company's mission; 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
- 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
- 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
- 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 organization
- 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
Excellent interpersonal communication skills
Creative problem solving skills
Strong team player and team building skills
Strategic thinking with proven ability to communicate a vision and drive results
- Licensed physician; Board Certified in an ABMS or AOBMS specialty
- 5+ years clinical practice experience; strong knowledge of managed care industry and the Medicaid line of business
- 2+ years Quality management experience
- Experience in Value Based Contracting / Risk contracting
- Familiarity with current medical issues and practices
- Superior presentation skills for both clinical and non-clinical audiences
- Proven ability to develop relationships with network and community physicians and other providers
- Excellent project management skills
- Solid data analysis and interpretation skills; ability to focus on key metrics
- Demonstrated negotiation and conflict management skills
- Proficiency with Microsoft Office applications
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.