UnitedHealthcare - Chief Medical Officer - Community & State

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 optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

The Chief Medical Officer (CMO), Medicaid (Community & State), is the senior clinical executive accountable for enterprise clinical strategy, medical oversight and performance outcomes across the Medicaid portfolio. The CMO reports directly to the Chief Clinical Officer of United Clinical Services (UCS) and has a dotted line (indirect) reporting relationship to the CEO of Community & State.The CMO sets the clinical vision, drives measurable improvement in quality, equity, access and affordability, and ensures disciplined execution through a national, matrixed organization spanning health plans, shared services and Optum partners.

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

Hybrid in MN/DC: This position follows a hybrid schedule with four in-office days per week.

Primary Responsibilities:

• Clinical strategy & product clinical model: In collaboration with the Community & State leadership team, drives the end-to-end clinical strategy and Medicaid clinical model across Community & State, ensuring competitiveness, compliance, operational efficiency and affordability; establishes governance and a disciplined operating cadence across markets and shared services

• Program design, measurement & scaling: Use data-driven insight to identify opportunity areas; design and scale evidence-based clinical programs; collaborate with UCS clinical leaders and Clinical Program Review (CPR) to define KPIs and outcomes measures; conduct regular deep dives to enhance high-performing programs and redesign/retire those that do not meet expectations.Ensure programs leverage common clinical data model whenever possible to enable consistent analysis, modeling and trend prediction at an enterprise level

• Affordability & trend management: Partner with Healthcare Economics and UCS to set affordability targets; understand medical/pharmacy trend drivers; build and govern a pipeline of affordability initiatives; monitor progress and adjust strategies to achieve commitments. Maintain an active initiative pipeline, and hold markets, shared services and delegates accountable for results

• Market enablement & clinical integration: Partner with market CEOs and CMOs, UnitedHealthcare Networks and business leaders to adapt strategy to state requirements and local delivery models; support the evolution toward more integrated, value-based and incented models of care

• Quality, equity & member/provider experience: Drives initiatives to meet or exceed state and federal performance requirements, including HEDIS® and CAHPS® measures and applicable accreditation standards; drive measurable improvement in quality, equity, access and experience

• Regulatory engagement & advocacy: In partnership with the Community & State CEO, Legal and Regulatory Affairs, develop and execute proactive advocacy and relationship strategies with CMS, state Medicaid leadership and policymakers

• Utilization management & medical oversight: Provide executive oversight to ensure clinically sound and compliant medical policies, clinical benefits, utilization management and appeals and grievance practices across delegated and shared-service partners. Ensure all state-specific benefit designs, quality metrics and UM criteria are incorporated into clinical programs

• Growth enablement (RFPs/procurements): Support Medicaid procurement and growth by articulating the clinical model, value proposition and outcomes; inform solution design to meet regulator, provider and member expectations

• Capital stewardship & enterprise representation: Supports and provides recommendation on investments in clinical capabilities to maximize impact across compliance, affordability, quality and operational efficiency; represent Community & State in external forums aligned to Medicaid clinical priorities

Executive Competencies

• Executive leadership experience within a Medicaid payer, state Medicaid agency, health system or large physician organization; proven ability to set clinical strategy and deliver measurable results

• Influence-based leadership in complex, matrixed environments; ability to align diverse stakeholders, clarify decision rights and drive enterprise execution

• Strong performance management orientation uses analytics, benchmarks and operating mechanisms to ensure accountability and continuous improvement

• Credible external presence with ability to build trusted relationships with providers, community partners, regulators and policymakers

• High integrity and sound clinical judgment; demonstrated commitment to compliance, program integrity and ethical decision-making

• Executive communication skills, including the ability to translate clinical strategy into clear, compelling narratives for C-suite, regulators and external audiences

Position Context & Scope

• Member of the Community & State Executive Team and UnitedHealthcare Clinical Services leadership representing Medicaid clinical priorities across the enterprise

• Collaborates with the Community & State leadership team to drive clinical performance and drive clinical policy

• Oversees UCS C&S CMO leadership team

• Senior clinical liaison with CMS and state Medicaid agencies; supports advocacy, program integrity and contract performance

• Provides clinical guidance for market-level CMOs and clinical leaders, leading through influence across multiple geographies and business units

• Accountable for clinical governance and performance management across quality, care management, utilization management and affordability programs, including consistent measurement and executive reporting

Key Partners & Stakeholders

• Community & State CEO and Executive Team; market presidents and health plan leadership

• UnitedHealthcare Clinical Services (quality, utilization management, clinical policy, care management, Clinical Program Review)

• Healthcare Economics and Finance (trend analysis, affordability targets, investment governance, objective evaluation of clinical program outcomes and ROI)

• Optum clinical, care delivery and analytics partners (program execution and outcomes measurement)

• UnitedHealthcare Networks (UHN) and provider partners (network performance, clinical alignment, value-based care)

• Legal, Compliance and Regulatory Affairs (program integrity, contractual requirements, advocacy)

• CMS and state Medicaid agencies; community and public-sector stakeholders
  

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; board certification in an ABMS or AOBMS specialty

• 12+ years of clinical practice experience; solid knowledge of the managed care industry

• 8+ years in a significant leadership role within a large clinical organization, payer or public-sector health program

• 5+ years experience in managed Medicaid

• Demonstrated executive presence, interpersonal effectiveness and ability to influence senior leaders and external stakeholders

• Solid written, verbal and presentation skills for clinical and non-clinical audiences

• Solid data analysis and interpretation skills with a focus on key performance metrics

• Proven ability to build relationships with network and community physicians and provider organizations

• Strategic thinking with a track record of communicating a vision and driving results

• Experience leading clinical strategy within Medicaid managed care, Medicare managed care and/or alternative payment models

• Demonstrated experience partnering with state Medicaid agencies, CMS and other regulators

*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.

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.