MinnetonkaRecruiter Since 2001
the smart solution for Minnetonka jobs

Chief Medical Officer, Medicare & Retirement - Telecommute (Physician

Company: Optum
Location: Minnetonka
Posted on: September 12, 2020

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)

Reporting to the Chief Medical Officer of UnitedHealthcare, the Chief Medical Officer (CMO) Medicare & Retirement (M&R) will use her/his proven track record to become the end-to-end owner of clinical programs for this population. The M&R CMO will be a member of the UnitedHealthcare Clinical Services (UCS) leadership team representing the M&R line of business, driving clinical data analysis, identifying opportunities and overseeing the design and implementation of programs that deliver value by improving clinical and cost outcomes. The CMO will collaborate with UCS and Healthcare Economics on using benchmarks in data-driven program design, monitoring execution, evaluating outcomes, and creating standardized, rigorous reports on program performance.
The Chief Medical Officer will also be a member of the M&R Executive Team. In that capacity, this position serves as senior clinical liaison with the Center for Medicare and Medicaid Services, all clinical product offerings, clinical market strategies, and clinical support for sales and growth opportunities. The CMO will oversee development and implementation of initiatives to meet Quality standards, ensuring Compliance with Medicare and state Medicaid compliance standards-where applicable, and appropriate capital stewardship.
You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities: 1. Accountable for market strategies to meet customer needs as end-to-end owner of the clinical product offerings for Medicare & Retirement. Continuously improve / update the clinical model for program competitiveness, compliance, efficiency and affordability.

  • Collaborate with UCS to develop clinical model for all products
  • Provide strategic clinical leadership of medical staff and programs throughout M&R
  • Monitor value and performance, regularly evaluating program outcomes, quality, affordability and operational results with defined metrics to hold shared services teams accountable. Ensure that program outcomes are available to meet CMS Star Ratings clinical quality measures and demonstrate our value proposition. Goals include:
    • Coordinate and oversee the clinical initiatives provided by Optum, focused on clinical outcomes and ROI
    • Establish process metrics to continuously monitor program performance, outcomes and ROI (including clinical initiatives and programs provided by Optum)
    • Use results to continuously improve program offerings
    • Retool or replace ineffective programs
    • Design/make available outcome studies to support RFP process
    • Quarterly deep dive review of clinical programs with shared services and delegates to ensure clinical model effectiveness
    • Ensure continuously developing efficiencies in delivering clinical model by shared services and delegates
    • Align with shared services capabilities as much as practical and consistent with federal and state mandates, including:
      • Medicare Advantage
      • Medicare Supplemental plans
      • Special Needs Plans
      • Medicare-Medicaid Programs (MMP)
      • Part D plans
      • 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 M&R. Monitor the industry for emerging affordability plays. Develop pipeline of affordability initiatives. Goals include:
        • Collaborate with UCS to establish affordability targets
        • Ensure that shared services and delegates appropriately understand their accountability and have plans in place to meet/exceed targets
        • Continuously evaluate trend and address key drivers
        • Continuously monitor progress toward goals and adjust as necessary
        • Participate with network and operations to achieve targeted savings on UCRT, recoveries, and Fraud and Abuse
        • Develop pipeline of initiatives by participating in development across the business, mining playbooks, evaluating existing UHC programs not currently deployed to M&R, and evaluating competitor strategies and behaviors
        • Work with regional CMO, UnitedHealthcare Networks (UHN), and business leaders to:
          • Adapt the clinical strategy for different environmental circumstances (e.g., a FFS/PPO market vs a capitated/HMO market)
          • Develop a clear evolution path to our desired state, moving from a fragmented FFS market to an integrated and incented market
          • Drive performance on clinical programs to achieve quality, service and affordability goals
          • Provide local, regional and national cross-functional support, clinical insight and expertise to assist in Medicare Advantage member growth
          • Provide strategic clinical insight and expertise across the enterprise to support ongoing M&R sub-product integration and growth
          • Collaborate with UCS and clinical functional leaders to ensure alignment of priorities/plans and eliminate redundancy/overlap. This includes UHN, HouseCalls, ADDC, Optum Clinical Services, Star Ratings, Quality, and Pharmacy, as well as Medicate Advantage Product, Regions and Finance 2. Ensure services are delivered to members at the highest quality standards. Oversee and ensure development and implementation of initiatives to meet or exceed Star Ratings at bonus-level thresholds, HEDIS-- quality standards, and accreditation standards through working with and holding Quality Shared Services accountable. Continuously improve Star Ratings, HEDIS--, and CAHPS-- scores for members and providers.
            3. Support the annual Medicare Advantage bid process through superior clinical product design, developing product offerings that will meet and exceed regulator and member expectations. Work with field leadership and product teams to understand competitor offerings and counter with superior programs. Develop a roadmap/pipeline of product offerings. Goals include:
            • Collaborate with M&R marketing and sales to establish competitive and clinically appropriate benefit plan designs
            • Review market opportunities for product offerings, providing clinical expertise in establishing medical and pharmacy benefits that maximize value to customers
            • Develop a pipeline of programs to meet emerging market requirements and competitor offerings. Bring field leadership and product into discussion around changing and evolving clinical programs requirements
            • Develop off-the-shelf benefit plan designs and clinical programs, in collaboration with the field, UHN, Product and clinical shared services, for deployment in various and diverse market opportunities, including:
              • Health and wellness
              • Preventive health
              • Member incentive programs
              • Provider incentive programs
              • Medical Home/Accountable Care Communities
              • Disease/Condition management 4. Collaborate with M&R CEO, Legal, and Regulatory Affairs, actively engaging to develop and implement proactive advocacy and relationship strategy with CMS leadership, program directors, and other policymakers. Goals include:
                • Develop relationships with key liaison at leadership levels of CMS and in key regions
                • Understand CMS needs, priorities and objectives to anticipate and execute on those needs
                • Become trusted partner and company with CMS
                • Influence CMS to effectively promote UHC's advocacy agenda with thoughtful improvements in CMS policies and procedures 5. Oversee and ensure compliance with Medicare compliance standards around prior authorization, utilization review, and appeals and grievances through working with and holding accountable compliance, UCS, Optum, and other clinical delegates
                  6. Ensure deployment of capital to clinical programs to maximize returns on compliance, affordability, quality, and efficiency
                  Demonstrable Skills and Experiences:
                  • Proven record of executive leadership in a payer, health system or large practice group
                  • Experience in driving 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
                  • Ability to build a team through influence that values organizational success over personal success; drive exceptional performance by provide ongoing coaching and feedback; identify and invest in high potentials; actively manage underperformance
                  • Execute with discipline and urgency: 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
                  • 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..... click apply for full job details

Keywords: Optum, Minnetonka , Chief Medical Officer, Medicare & Retirement - Telecommute (Physician, Healthcare , Minnetonka, Minnesota

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category

Other Healthcare Jobs

Nursing Assistant / CNA / HHA.
Description: We are seeking Full Part Time Nursing Assistants to join our team at our Folkestone community in our Care Center / Long Term Care or Assisted Living. These positions include working every other weekend (more...)
Company: Presbyterian Homes & Services
Location: Wayzata
Posted on: 09/21/2020

Description: 1st Choice Pediatric Home Care is seeking outgoing, ambitious nurturing RNs LPNs for our
Company: 1st Choice Pediatric Home Care
Location: Farmington
Posted on: 09/21/2020

Licensed Marriage and Family Therapists ( LMFT ) Remote Online Counseling (Northfield)
Description: Licensed Professional Counselors LPC , Licensed Clinical Social Workers LCSW , Licensed Marriage and Family Therapists LMFT , Psychologists, and Licensed Mental Health Counselors LMHC are provided (more...)
Company: BetterHelp
Location: Northfield
Posted on: 09/21/2020

Emergency Medicine Physician Job near Central, Minnesota (6582)
Description: Emergency Medicine opening in Minneapolis, Minnesota. This and other physician jobs brought to you by DocCafe.com Live in the sportsman paradise of the
Company: HDA MD Staff
Location: Minneapolis
Posted on: 09/21/2020

Licensed Mental Health Counselor/Therapist for Online Therapy
Description: Private practice with no doors and no overhead. 10 10 Join the world 38 039 s largest online counseling platform. 10 10 We provide the marketing, the technology, and the additional income. You (more...)
Company: BetterHelp
Location: Minneapolis
Posted on: 09/21/2020

Licensed Practical Nurse (LPN)
Description: Presbyterian Homes 38 amp amp Services is seeking a Licensed Practical Nurse to join our team at Harmony River in Hutchinson, MN. We are currently hiring for: 10 10 A Part Time, .3, Evening schedule (more...)
Company: Presbyterian Homes & Services
Location: Hutchinson
Posted on: 09/21/2020

Comfort Keepers: Part Time Caregiver Position
Description: Experience the difference
Company: Comfort Keepers
Location: Buffalo
Posted on: 09/21/2020

Registered Nurse (RN)
Description: We are seeking a Registered Nurse to join the Folkestone team in Wayzata, MN. We are currently hiring for a Full Time , .8, Overnight schedule in LTC 10:30PM-7AM . 1 year of nursing experience required. (more...)
Company: Presbyterian Homes & Services
Location: Wayzata
Posted on: 09/21/2020

Registered Nurse (RN)
Description: Presbyterian Homes 38 amp amp Services is seeking a Registered Nurse to join our team at Harmony River in Hutchinson, MN. We are currently hiring for: 10 10 A Full Time Evening schedule in LTC (more...)
Company: Presbyterian Homes & Services
Location: Hutchinson
Posted on: 09/21/2020

Nationwide Travel RN Nursing Jobs - All Specialties
Description: Seasonal Travel Nurses - All RN Specialties br No more long application, no hunting down license numbers, dates of employment, reference names and contact information just to get information on whether (more...)
Company: HealthCare Travelers
Location: Minneapolis
Posted on: 09/21/2020

Log In or Create An Account

Get the latest Minnesota jobs by following @recnetMN on Twitter!

Minnetonka RSS job feeds