Community & State Chief Medical Officer - Missouri - Virtual

Company: UnitedHealth Group
Location: Charlotte
Posted on: September 24, 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)

Looking for a chance to drive measurable and meaningful improvement in the use of evidence-based medicine, patient safety, practice variation and affordability? You can make a difference at UnitedHealth Group and our family of businesses in serving our Medicare, Medicaid and commercial members and plan sponsors. Be part of changing the way health care is delivered while working with a Fortune 6 industry leader.

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.

If you are located in Missouri, you will have the flexibility to telecommute as you take on some tough challenges.

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 Accountable Care Community relationships, target setting and JOC leadership. Support UnitedHealthcare Network (UHN) initiatives, Quality and Affordability Programs as required 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 Missouri C&S plan and will collaborate with the plan Quality Director to manage this responsibility. 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. The Plan CMO will lead clinical rounds with the health plan care management team, as well as other UHC/UCS partners
• Relationship Equity and State Compliance - The Plan CMO maintains a strong working knowledge of all government mandates and provisions for the Missouri C&S market, as well as working across the enterprise to implement and maintain compliant clinical programs and procedures. The CMO 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
• 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, target setting, 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 health equity
• 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. The plan CMO actively promotes positive relations with State/local regulatory authorities and Medical Societies
• 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 Health Services as needed. Additional responsibilities developing action plans for sub-optimal results; and taking a leadership role in Quality Affordability Programs initiatives
• Appeals and Grievances (A&G) - the Plan CMO maintains an active liaison with UCS A&G and is responsible for representing the local C&S plan at State Fair Hearings Demonstrable Skills and Experiences:
  • 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 Leadership Expectations:
    • 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..... click apply for full job details

Keywords: UnitedHealth Group, Charlotte , Community & State Chief Medical Officer - Missouri - Virtual, Executive , Charlotte, North Carolina