Job Details

Chief Medical Officer

At UnitedHealthcare, were simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing Together.

The C&S Plan Chief Medical Officer has accountability for ensuring that Washington health plan, Enterprise Clinical Services (ECS) and UnitedHealthcare (UHC) initiatives focusing on clinical excellence, quality improvement, member experience with their health care, appropriate inpatient and outpatient utilization, affordability, health system transformation including provider network, compliance with regulatory mandates, growth and other focused improvements are implemented and successfully managed to achieve goals. This position reports to the Washington C&S health plan Chief Executive Officer and has a dotted line relationship to the C&S West National Chief Medical Officer. The Washington C&S Plan CMOs primary responsibilities are directed towards C&S plan activities as defined by the C&S plan CEO. The WA C&S CMO collaborates with other health plan leadership (COO, CFO, Health Services Director) along with Enterprise Clinical Services (ECS), commercial and Medicare business sector leadership and other market and regional matrix partners to support and implement programs to meet C&S health plan, C&S line of business, ECS and UHC goals.

If you are located in Washington, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

Quality and Affordability - The Plan CMO has primary responsibility and accountability for health care quality, efficiency, customer, and provider satisfaction results, achieving performance targets for the Washington C&S plan. This will require close working relationships with regional and national programs and teams within UnitedHealthcare, Optum and UnitedHealth Group. The CMO will work with teams focused on Pharmacy, Behavioral Health, Complex Care (such as Transplant, Neonatal Resource Solutions, and others, as well as with the C&S and ECS national affordability teams. Activities will include responsibility to oversee new clinical model operations, collaborations with community agencies and development work such as Accountable Community of Health (ACH) relationships, and new Models of Care such as those defined by CMS.Additional responsibilities include conducting Joint Operations Committee meetings with prioritized providers (such as health systems, hospitals, primary care networks, FQHCs) in coordination with UnitedHealth Network (UHN) and ECS, data sharing with physicians and physician groups on quality and efficiency improvement opportunities, completing peer to peer communications as required, and implementing local and national health care improvement and affordability Initiatives in order to achieve inpatient and outpatient quality, utilization, and affordability goals

Clinical Excellence - The C&S plan CMO works with health plan clinical leaders for Quality and Health Services to improve quality and promote evidenced-based medical care that is efficient, effective, and satisfying for members and providers. The CMO and plan clinical leaders develop and maintain the Quality and Utilization Management Program Descriptions and Evaluations for the health plan, assuring compliance with state and federal regulations, contracts, and accreditation requirements. The CMO also oversees the quality measurement and improvement programs, such as HEDIS and Stars, working with plan leaders to maintain accreditations and drive improved member satisfaction and quality metric improvements.

Relationship Equity and State Compliance - The Plan CMO maintains a solid 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. The CMO also actively and effectively engages with external constituents such as consumers/members, physicians, medical and specialty societies, hospitals and hospital associations, federal/state regulators, and market-based collaboratives. The C&S plan CMO will work collaboratively in these activities with UHCs clinical and business program leadership, assuring that core services are providing excellent performance for the plan.The Plan CMO will be the health plans clinical program authority and spokesperson to State regulators based upon Contract and direction of Plan CEO. The C&S CMO will provide clinical thought leadership within the plan and UnitedHealthcare, and with external entities and the state

Innovation-The Plan CMO leads the clinical interface with care providers and UnitedHealth Network colleagues in efforts to transform the health system. The CMO works to support and improve UnitedHealthcares clinical practice transformation efforts, collaborating within the local health care community and working with UnitedHealthcare and Optum programs to understand social determinants of health, identify and mitigate or resolve inequities and disparities in access to and outcomes of health care, improve the simplicity and capability of systems of care, and expand accountable care organizations and value-based provider partnerships

The CMO contributes to identification of appropriate practices, initial contact and target setting, and implementation, as well as ongoing leadership during meetings with engaged practices. The CMO and Health Services Director are accountable for oversight of the entire clinical model (end to end) within the plans service area and market community. Knowledge of alternative payment model variants for C&S will be essential, including patient-centered medical homes, accountable care organizations, creative care management programs, case-rates and bundled payments, high-performance networks and network optimization, and consumer engagement

Growth - The CMO delivers the clinical value proposition focused on quality, affordability, and service, in support of growth activities of the C&S Health Plan.The plan CMO reviews and edits communications materials as required and represents the voice of the market-based customer in program design. CMO contributes to any RFP/re-procurement activity in the state. The Plan CMO actively promotes positive relationships with State/local regulatory authorities, the health professions, and the community at large

Focused Improvement -The Plan CMO is responsible for identifying opportunities through participation in regional and local Market reviews, and healthcare economics analyses.S/he actively participates in various Joint Operating Committees. S/he also provides oversight of the performance of Enterprise Clinical Services including the Inpatient Care Management team and Clinical Coverage Review team (prior authorization), Appeals and Grievances, Optum Behavioral Solutions, Optum Physical Health, OptumRx and other Optum Health teams

Grievances and Appeals- the Plan CMO maintains an active liaison with UnitedHealth A&G and is responsible for representing the Washington C&S plan at state-level Fair Hearings

Human Capital - the Plan CMO embraces, supports, and helps to continuously improve the companys positive and inclusive workplace culture. The CMO directly manages a variable number of staff and contributes to personnel management throughout the health plan

Demonstrable Skills and Experiences:

The CMOs skills and experiences will encompass all 5 of UnitedHealthcares core values- integrity, compassion, relationships, innovation, and performance

Proven ability to execute and drive improvements against stated goals. Drive disciplined fact-based decisions through effective use of financial knowledge and data (performance, integrity)

Deliver value to members by optimizing the member experience and maximizing member growth and retention (performance, compassion)

Lead and influence Health Plan employees by fostering teamwork and collaboration, driving employee engagement, and leveraging diversity and inclusion (relationships, compassion)

Develop and mentor others while also building awareness to your own strengths and development needs; identify and invest in high-potential colleagues; actively manage underperformance (relationships, performance)

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 (relationships, performance)

Influence and negotiate effectively to arrive at win-win solutions (relationships, performance)

Communicate expectations and present effectively, listen actively and attentively to others, and convey genuine interest (relationships, compassion)

Execute with discipline and urgency: Drive exceptional performance; deliver value to the customer; closely monitor execution; drive operational excellence; get directly involved when needed and delegate work to maximize productivity; actively manage financial performance; balance speed with analysis; ensure accountability for results. CMO is a leadership position within the health plan, a part of the C Suite, a skilled General Manager with clinical expertise (all 5)

Broad range of clinical expertise, able to represent health plan goals in context for wide range of clinical care, including behavioral health integration, improved care for diverse disadvantaged populations, in many health care settings - primary and specialty care, hospital and facility care, and use of community and ancillary services (relationships, integrity, performance)

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 (innovation)

Model and demand integrity and compliance (integrity)

Has a positive, flexible, and informed account management approach when working with members of the Washingtons Health Care Authority and other governmental stakeholders (relationship)

Visibility and involvement in medical community (relationships, compassion)

Experience and capability as a general medical expert witness for appeals dispute resolution processes, such as state Fair Hearings (performance, integrity, compassion, relationships