UnitedHealthcare, National Medical Director – Specialty Content & Care Pathways

At UnitedHealthcare, we’re 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 Chief Medical Officer of Specialty Content and Care Pathways is responsible for modernizing all aspects of prior authorization and retrospective clinical review.  This role will partner with teams and leaders across Optum Health, Optum Insight and Enterprise Clinical Services to review, evaluate, advise and drive new program innovation and program enhancements. The role will evaluate the financial viability of program components, recommend changes as applicable, lead all program development efforts and will be accountable for post-deployment measurement of results to drive continuous program improvement.

 

This position will report to the Senior Vice President of Value Creation for UnitedHealthcare and will be responsible for developing clinical content across a wide array of medical specialties and procedures. The role will work with leaders across the enterprise to develop and build the program value proposition with a focus on the modernization of prior authorization and retrospective clinical review. This role will assume oversight and drive execution with Optum Enterprise Clinical Services and all UM program components in an effort to reduce medical necessity denials, improve member care, improve member and provider NPS and reduce provider abrasion.  This role will drive the development of new specialty clinical content and will work to establish optimal care pathways for UnitedHealthcare members.

 

This position will be a critical member of the UCS leadership team. This role requires a strategic mindset with the ability to handle multiple priorities as well as the ability to articulate and represent both UHC and Optum’s strategy to executive leaders across the enterprise and external partners.  

 

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• The Chief Medical Officer must have a proven track record across multiple areas of Utilization Management demonstrating effective design and monitoring of UM programs in the Payer space
• The Chief Medical Officer will partner closely with teams in Clinical Operations, Technology, Finance and Health Care Economics to design, implement and monitor all aspects of program development
• The Chief Medical Officer will lead a cross functional team of medical directors and their clinical teams across multiple specialties with focus on Cardiology, Routine and Specialty Lab, Musculoskeletal, Oncology, Radiology and Specialty Medications. The leader will give direction to a team of program and product managers who are responsible for driving day to day execution
• The Chief Medical Officer will regularly review program metrics including all operational, financial and clinical outcomes to inform future strategic direction

Quantitative and Qualitative Analysis & Strategic Problem Solving

• The team often requires evaluation of data sets and/or development of research methods to evaluate program results
• The Chief Medical Officer works with experienced data analysts who perform the technical data retrieval and analysis
• The Chief Medical Officer must be able to direct the analytics team as they work to problem solve, innovate and summarize program results
• The work requires financial modeling to calculate the cost and return of the programs
• The Chief Medical Officer works with financial experts on the team to assure model assumptions are accurate
• The leader should be comfortable making decisions using input from subjective sources

Communication Skills and Executive Presence

• The chief medical officer is the face to external and internal customers and must possess the ability to speak clearly on complex problems
• Audience size ranges from small teams to audiences more than 1,000
• Build and develop relationships across teams to ensure effective feedback loops and that key program milestones are met
• Collaborates with the Chief Medical Officer of UnitedHealthcare and various members of the UnitedHealthcare Clinical Leadership Team and Optum leadership teams on top priorities and goals

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:

• Doctor of Medicine (MD or DO) degree with unrestricted medical license
• ABMS specialty preferred
• 15+ years of healthcare experience in a Payer, Health System or large Clinical Practice
• 10+ years of management experience with a proven track record designing and implementing large scale Utilization Management programs
• Demonstrated proficiency using InterQual, or other evidence-based guidelines, as it relates to clinical decision making
• Familiar with URAC and NCQA UM requirements
• Solid belief in evidence-based medicine
• Demonstrated ability to understand program performance data including financial impact data as well as program auditing and compliance review results
• Solid strategic, analytic and critical thinking skills with proven ability in designing, implementing and ongoing evaluation of program outcomes
• Demonstrated ability to directly inform program design, systems development and implementation of IT systems to support Utilization Management innovation
• Experience in overseeing the execution and metric-driven performance evaluation of vendors, operations teams and financial return on investment
• Proven ability to drive, lead and communicate change effectively in a fast-paced environment and be adaptable within the changing environment
• Ability to make strategic, operational and administrative decisions in response to emerging program insights
• Ability to lead large scale program implementations
• Solid ability to communicate effectively and efficiently (both verbal and written) at multiple levels of large, complex organizations
• Motivate, mentor and influence others within your direct hierarchy and at various levels across the organization
• Solid organizational, management, administrative and human relations skills, and a style which exhibits emotional maturity, leadership, collaboration and teamwork
• Experience delivering effective public presentations
• Ability and willingness to travel

 

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $225,000-$375,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

 

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

 

 

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.