Community & State Indiana Health Plan Chief Medical Officer - Indiana Virtual - Relo Avail

Company: UnitedHealth Group
Location: San Antonio
Posted on: September 24, 2022

Job 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)

The Community and State (C&S) Plan Chief Medical Officer (CMO) has accountability for United Healthcare and United Clinical Services initiatives focusing on delivering clinical excellence, quality ratings improvement, appropriate inpatient and outpatient covered-service utilization and health care affordability with the goal to be best in class. Chief Medical Officers are expected to help drive integrated health system transformation including working with facilities, provider groups, and provider organizations, assisting to address provider network engagement and issues, supporting mandated legal and contractual provisions, compliance, growth strategies and developing/leading focused improvement projects that are implemented and successfully managed to achieve goals.

This position reports to the local C&S Plan Chief Executive Officer. The C&S Plan Chief Medical Officer primary responsibilities are directed towards C&S plan activities as defined by the C&S plan CEO and collaborates with Enterprise Clinical Services (ECS) staff and other market and regional matrix partners to implement programs to support and meet market C&S, UHC and line of business goals.

If you are located within the State of Indiana, you will have the flexibility to telecommute as you take on some tough challenges.

Primary Responsibilities:

• Quality + Affordability - The Plan Chief Medical Officer has primary responsibility and accountability for medical performance and targets for the local C&S plan(s) being overseen. local plan staff, and UCS as well as with the C&S and UHC national affordability team. Activities may include conducting Joint Operations Committee meetings with prioritized providers, in coordination with Network and ECS, contributing to and implementing programmatic and strategic decisions, data sharing with physicians and physician groups on quality and efficiency improvement opportunities, and implementing local Health Care Affordability Initiatives. The Chief Medical Officer will be engaged as a clinical lead for healthcare affordability initiatives at the local market and establishing a process for sharing data and completing peer to peer communications as required. They will support medical dental, pharmaceutical, and or social initiatives and quality programs as required to achieve the appropriate utilization, affordability, HEDIS and Star goals of the C&S Health Plan. The Chief Medical Officer is accountable for building and leaning into relationships with internal and external partners to meet or exceed market, regional and national requirements. They have contributing oversight responsibility of the C&S market peer review process. as defined by State regulator as well as participating in or leading the applicable committees such as the Provider Advisory Committee (PAC), Quality Management Committee (QMC) and the Utilization Management Committee (UMC). They will work with teams to direct all member care to in-network providers unless care cannot be provided in network and in state. In which case, they will work with the Provider teams to complete single case agreements for the highest quality and most cost-effective care.
• Clinical Excellence, Quality Standards and Service Performance - The C&S plan Chief Medical Officer oversees and contributes to HEDIS and CMS Stars process improvement and performance strategy, CAHPS and Net Promoter Score improvement strategies and supports necessary Health Plan accreditation activities. The plan Chief Medical Officer is required to help achieve or exceed all applicable HEDIS, Stars and local state performance targets and goals otherwise specified for the local C&S plan. The Chief Medical Officer should act as an improvement catalyst for all service and quality-related efforts, influence, participate and communicate to network providers or vendors on new focus and measure/process changes. The Chief Medical Officer supports all Clinical Quality initiatives and peer review processes including Quality of Care and Quality of Service (grievance) issues and is responsible for representing the local C&S plan at State-level Fair Hearings and performing plan-level member/provider grievance and appeals reviews, as necessary. The Chief Medical Officer will oversee the development and implementation of the Contractor's disease management, case management, and care management programs; oversee the development of the Contractor's clinical practice guidelines; review any potential quality of care problems; oversee the Contractor's clinical management program and programs that address special needs populations and health screenings.
• Innovation and Focused Improvement - As Chief Medical Officer, a culture of innovation and continuous improvement identification is to be incorporated at all levels of work. They are expected to collaborate with peers and colleagues in efforts to transform the health system and exceed all regulatory expectations. Local responsibilities include driving/supporting delivery system transformation growth and performance improvement, target setting and monitoring, as well as ongoing leadership during monthly JOCs. Knowledge of payment reform and value-based contracting variants for C&S will be required. Secondary responsibilities will include, but are not limited to, other clinical practice transformation efforts, patient-centered medical and behavioral health homes, innovative vendor and provider-led care coordination programs, health disparity assessments and action planning, high-performance network development and consumer engagement.
• Growth, Equity, Inclusion and Diversity - The Chief Medical Officer will help deliver our clinical value proposition focused on quality, affordability, and service, in support of growth activities of the C&S Health Plan, consistent with our prevailing values and culture. The plan Chief Medical Officer reviews and edits policies, SOPs, communications materials as required and represents the voice of the market-based customer in program design. Chief Medical Officer contributes to any RFP/re-procurement activity in the state, as requested, delivering subject matter expertise and clinical perspectives. The Plan Chief Medical Officer actively promotes positive relations with State/local regulatory authorities and Medical Societies, where possible, will participate with partner organizations, health equity and disparity efforts such as the DE&I council, promote cultural competencies and other factors which holistically help the health plan better meet community and member needs.
• Relationship Equity and State Compliance - The Plan Chief Medical Officer maintains a strong working knowledge of all government mandates and provisions for the local C&S market, as well as working across the enterprise to implement and maintain compliant clinical programs and procedures. They participate as a Subject Matter Expert (SME) in reviewing work plans and in operational reviews and audits. They also are committed to being effectively and positively engaged with our external constituents such as consumers/members, physicians, medical and specialty societies, hospitals and hospital associations, federal/state regulators, and market-based collaborative. The Chief Medical Officer will work collaboratively in these activities with ongoing ECS and C&S initiatives under the direction of the Plan CEO, C&S National CMO and/or the C&S Regional CMO. The Plan Chief Medical Officer will be called upon to support outward facing relationships to State regulators based upon contract, Plan CEO and C&S CMO and should provide clinical thought leadership with external entities and the state. The Chief Medical Officer, in close coordination with other key staff, is responsible for ensuring that the medical management and quality management components of the Contractor's operations are compliant with the terms of the State Contract. The Chief Medical Officer shall work closely with the Pharmacy Director to ensure compliance with pharmacy-related responsibilities The Medical Director shall attend all FSSA quality meetings, including the Quality Strategy Committee meetings and Subcommittee meetings. Skills, Experiences, Qualifications
  • Ability to support and contribute to a team that values organizational and Plan success over personal success; provide ongoing coaching and feedback with colleagues and other team members to ensure peak performance; identify and invest in high-potentials; actively manage underperformance.
  • Focus staff on the company's mission and values; inspire superior performance; ensure understanding of strategic context; set clear performance goals; focus energy on serving the customer; provide ongoing communication to the team; discontinue non-critical efforts.
  • Demonstrate pro-active, solution-oriented approaches to work efforts and drive disciplined, fact-based decisions.
  • Execute with discipline and urgency: Drive exceptional performance; 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. Chief Medical Officers are a leadership position within the health plan, key contributors to the "C" Suite level team, a skilled General Manager with a clinical expertise. ..... click apply for full job details

Keywords: UnitedHealth Group, San Antonio , Community & State Indiana Health Plan Chief Medical Officer - Indiana Virtual - Relo Avail, Healthcare , San Antonio, Texas