UnitedHealthcare Market Chief Medical Officer
Employer & Individual
UnitedHealthcare’s Market CMOs serve as the local senior clinical executive for their line of business, with accountability for:
- Achieving defined clinical outcomes, affordability goals and growth targets, in partnership with their health plan leadership team
- Provide clinical insight into market data and implementing tailored interventions to address clinical trends and opportunities for their state or region
- Serving as a central health plan leader accountable to facilitate coordination with UnitedHealthcare and Optum national clinical and operational functions
- Actively engage and help drive performance with market-level quality, network, and compliance teams
- Building and deepening relationships with area hospitals, physicians, and other health care providers
- Advocate for UnitedHealthcare’s clinical value story, evidence-based medical policies, and member health with government/state regulatory entities, professional and medical society chapters, employers, and as part of external communications and media relations
- Provides subject/specialty based clinical expertise and leadership to UCS and the enterprise, as needed
Primary Core Accountabilities
- Clinical Affordability – CMOs are responsible for achieving their assigned incremental savings goal and support the national savings target for the year. Driving savings is a two-pronged, data-driven approach of local response and national implementation, where CMOs lead targeted clinical inventions to address local market trends and needs, and support on-the-ground alignment with national utilization management programs. Inform and drive local and national affordability initiatives: CMOs are expected to apply healthcare economics insights and escalate local issues and trends.
- Network / Provider Engagement – The CMO serves as the local clinical point of contact for physicians, systems, and other care providers and with UnitedHealth Networks colleagues. Key activities include UHC’s Accountable Care Platform, value-based contracting, clinical practice transformation, patient-centered medical homes, and transparency initiatives such as UnitedHealth Premium® Designation and/or High Performing Physicians. The CMO meets regularly with hospitals and physician groups and shares data on quality and efficiency improvement opportunities and developing action plans for sub-optimal results.
- Market Relationships – The CMO is the clinical face of UnitedHealthcare to elected officials, policy makers, plan sponsors, medical and professional societies, news media, and community-based organizations. The CMO is engaged in regular, proactive dialogue with our external constituents to advance evidence-based medicine and support best practices in health care delivery.
- Quality & Compliance – The CMO maintains a strong working knowledge of all government mandates and provisions, working across the enterprise to implement and maintain compliant clinical programs and procedures. The CMO also supports quality improvement efforts as measured by CMS Star Ratings, NCQA Star Ratings, HEDIS, CAHPS, HOS and other national and company metrics. The CMO partners with UHC Compliance to ensure clinical management regulatory obligations regarding clinical management are met. Market CMOs also chair required Quality Oversight Committees at a market/regional level.
Market Chief Medical Officer
Line of Business Addendum – Employer & Individual
Role Overview – See universal job description for full details.
Primary Core Responsibilities– See universal job description for full details.
- Clinical Affordability
- Network Development
- Constituent Relationships
- Quality & Compliance
CMO Pod/High Impact Rounds – This CMO serves as the market lead of all clinical programs as they impact a member’s passage from enrollment thru end of life care. The CMO will hold daily rounds with Optum/UCS clinical partners to identify barriers, effect resolution, reduce internal and external cycle times, and integrate information flow with providers to reduce admissions/ readmissions. The CMO will produce and present weekly status reports, work plans, and results to the senior leaders of United Clinical Services on the performance of the market.
Affordability/Total Cost of Care – The CMO has responsibilities for utilization management from a macro view: conducting hospital Joint Operations Committee meetings, contributing to--and implementing--regional Medical Cost Operating Team decisions, bed day action committee meetings with Inpatient Care Management (ICM), data sharing with physicians and physician groups on quality and efficiency improvement opportunities, and implementing local Health Care Affordability Initiatives. At a more micro level, the CMO will drive and manage Market ACO and delegated medical group performance and work with providers to close clinical quality gaps in care for HEDIS. This focus not only ensures affordability gains but also drives and reinforces the importance of the triple aim with strong emphasis on value realization at the market level which includes quality revenue, risk revenue and medical cost reduction.
This focus not only ensures affordability gains but also drives and reinforces the importance of the quadruple aim with strong emphasis on value realization at the market level.
Relationship Equity— The CMO maintains a strong working knowledge of all government/regulatory mandates and provisions, working across the enterprise to implement and maintain compliant clinical programs and procedures. Engagement in regular, proactive dialogue with our external constituents to continuously improve health care to enrollees and better products for our customers.
Growth – This CMO delivers the clinical value proposition focused on quality, affordability, and service, in support of the sales and growth activities of the Health Plan including conducting Broker/Client presentations and participating in customer consultations. The CMO reviews and edits communications materials as required and represents the voice of the market-based customer in program design. Actively promotes positive relations with State/local regulatory authorities and Medical Societies.
Focused Improvement – The CMO is responsible for identifying opportunities through participation in regional and local Medical Cost Operating Teams or Market reviews. Additional responsibilities include developing action plans for sub-optimal results; and taking a leadership role in United Clinical Services and Quality Affordability Programs initiatives.
- Active and unrestricted medical license for the assigned market(s)
- Reside in, or be willing to relocate to assigned market(s); preferably within proximity to UHC corporate offices
- Board Certified in an ABMS or AOBMS specialty
- 5+ years clinical practice experience
- Strong knowledge of managed care industry
- Familiarity with current medical issues and practices
- Excellent interpersonal communication skills and ability to influence in executive settings
- Superior presentation skills for both clinical and non-clinical audiences
- Strong knowledge of health care utilization data and analytics
- Proven ability to identify an improvement opportunity through data, implement a solution and achieve measurable impact. Solid data analysis and interpretation skills; KPI metrics driven.
- Ability/experience in developing collaborative relationships with health system clinical leadership
- Proven ability to develop relationships with network and community physicians and other providers
- Ability to travel within the assigned market—30% travel required
- Proficiency with Microsoft Office applications (Outlook, Word, Excel, PowerPoint)
- Capable to quickly become facile with UHC/UHG specific data systems
- Prior health plan experience in similar leadership capacity
- Advanced Business, Public Health, Medical Management degree
- 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
Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.SM
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.