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Chief Medical Officer, Medicare & Retirement - Telecommute (882694)

Company: UnitedHealth Group
Location: Minnetonka
Posted on: September 12, 2020

Job Description:

Improve the lives of others while doing your life's best work. SM Position 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

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications

Active, unrestricted medical license for the assigned market(s); Board Certified in an ABMS or AOBMS specialty

12+ years clinical practice experience; strong knowledge of managed care industry

8 + years’ experience in significant leadership role in large clinical or payer organization

Excellent interpersonal communication skills; ability to influence in executive settings

Superior presentation skills for both clinical and non-clinical audiences

Proven ability to develop relationships with network and community physicians and other providers

Solid data analysis and interpretation skills; ability to focus on key metrics

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

Proficiency with Microsoft Office applications (Outlook, Word, Excel, PowerPoint)

Ability to travel within the assigned market

Preferred Qualifications: Advanced Business, Public Health, Medical Management degree

Experience in Medicare Advantage and/or CMS policy and alternative payment models

Careers at UnitedHealthcare Medicare & Retirement. The Boomer generation is the fastest growing market segment in health care. And we are the largest business in the nation dedicated to serving their unique health and well-being needs. Up for the challenge of a lifetime? Join a team of the best and the brightest to find bold new ways to proactively improve the health and quality of life of these 9 million customers. You'll find a wealth of dynamic opportunities to grow and develop as we work together to heal and strengthen our health care system. Ready? It's time to do your life's best work.(sm)

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

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.

Job Keywords: telecommute, remote, work from home

Requisition Number 882694

Job Title Chief Medical Officer, Medicare & Retirement - Telecommute

Job Family Executive Leadership Team

Business Segment UnitedHealthcare Corporate

Job Location Information UnitedHealth Group is committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities. If you need special assistance or accommodation for any part of the application process, please call 1-800-561-0861 and press or say 1 for Applicant to be connected to Recruitment Services. Recruitment Services hours of operation are 7 a.m. to 7 p.m. CT, Monday through Friday.

UnitedHealth Group is a registered service mark of UnitedHealth Group, Inc. The UnitedHealth Group name with the dimensional logo, as well as the dimensional logo alone, are both service marks for the UnitedHealth Group, Inc.

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.

Keywords: UnitedHealth Group, Minnetonka , Chief Medical Officer, Medicare & Retirement - Telecommute (882694), Other , Minnetonka, Minnesota

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