CMO - UnitedHealthcare Community Plan of Maryland

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The Chief Medical Officer for UnitedHealthcare Maryland Community Plan is a key leadership position focused on ensuring the plan delivers patient-centered, high quality and efficient care for its Medicaid membership.  The position is responsible for overall clinical strategy and clinical model delivery, stewardship of external relationships including our State Partner and providers, improvement in quality and health outcomes metrics, affordability and cost savings initiatives, and development of new clinical programs including health homes.  The position will report to the Health Plan President and will be based in Maryland.
 
Primary Responsibilities:
 
Leadership and Program Development

Leadership:

Provides clinical leadership to the Health Plan, accountable for clinical outcomes of the plan
Ensure the organization delivers safe, high quality and efficient care for our members, as measured by clinical outcomes and quality measures
Serve as primary expert on clinical delivery, representing the clinical perspective within leadership and the organization
Interacts, communicates, and collaborates with network and community physicians, hospital leaders, and other vendors regarding clinical care and services for enrollees
Directs weekly team meetings and interdisciplinary rounds for communication, feedback, problem solving, staff training and development and sharing of program results
Leads health plan provider advisory councils and quality review committees
Affordability, Clinical Operations and Quality:

Leads the organization in identifying health care cost drivers and cost reduction opportunities, by leveraging data analysis and health care economics resources and tools
Develops and monitors utilization reports by product line, identifying changes in utilization or access patterns and monitor overall trends on a weekly basis
Designs and implements health programs that improve the health of our members and subsequently reduce clinical cost, partnering with internal program leads and with external provider partners
Leads internal teams in the tracking and management of clinical affordability programs
Oversees all quality efforts, including HEDIS data collection process, CAHPS and accreditation activities
Program development and execution:

Partners with local health services teams to ensure local clinical programs are executed appropriately, efficiently, effectively and within State compliance guidelines
Leads new clinical program development including Health Homes strategy, or other plan specific initiatives
Participates or co-lead accountable care program development, working with health plan and network leadership
Identify community and local partnerships for program innovation, development and improvement
State Partner Account Management:


Serves as key clinical representative with State across all clinical functions

Leverages understanding of State contract and State program objectives to ensure health plan is pro-actively advancing the State relationship, and positioning UHC as an innovative, clinical leader

Partners with community organizations and the provider community, as well as with colleague MCOs, to advance the health plan and State agenda

Provides team leadership on key industry clinical trends and innovative programs, challenging the organization to advance its clinical model
Clinical Oversight

Supports coordinate clinical operations and develop new cross functional processes when needed.  Collaborates with the internal utilization management and care coordination teams to establish and implement clinical programs to meet UM goals
Oversees daily review activities, and manages regular work flow including single case agreements, peer to peer reviews, state fair hearings, appeal reviews and level of care re-alignments
Participates actively to support development of quality improvement initiatives and programs
Demonstrated leadership ability and outcomes in a complex or large organizational setting
 

Required Qualifications:

Current and non-restricted licensed physician in the State of Maryland
Board Certified in ABMS specialty
5+ years’ post-licensure experience as a senior clinician and leader with responsibility for clinical standards, quality management, and clinical supervision in a health plan organization
Demonstrated accomplishments in the areas of medical care delivery systems, utilization management, quality management, and peer review
Strong operational focus with demonstrated data analysis / interpretation acumen, project management, change management, and execution skills
Self-motivated and able to work with little direct supervision and drive results with disciplined follow-though
Strong strategic thinking and business acumen with the ability to align clinical related strategies and recommendations with business objectives
Adaptable and flexible style of collaborating with key stakeholders in setting direction
Proven ability to quickly gain credibility, influence and partner with employees, business leaders and the clinical community
High integrity with a reputation of a trusted confidential advisor and partner
Visibility and involvement in medical community
Ability to develop relationships with network and community physicians and other providers
Excellent presentation skills for both clinical and nonclinical audiences
Preferred Qualifications:

5+ years’ experience in Medicaid/Medicare government programs or Medicare fee for services
 
 Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.(sm)
Diversity creates a healthier atmosphere: 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.