UnitedHealthcare - Chief Medical Officer, Medical Management

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.

This position will report to the Chief Medical Officer of UnitedHealthcare and will be responsible for the Medical Management program to ensure care is safe, effective and affordable. This executive will work with leaders across the enterprise to evaluate and build the medical program value proposition with a focus on inpatient care management, prior authorization, post-acute and discharge planning. This role will assume oversight and drive execution with Optum Enterprise Clinical Services as well as Optum MBM to reduce denials, improve member care, NPS and provider abrasion. The CMO, Medical Management will review, evaluate, advise and drive clinical programs presented by all lines of business, including delegation with internal affiliates and external entities. The CMO Medical Management will chair the Utilization Management (UM) Program committee and oversee the Delegation Oversight Committee.

This position will work closely with the UCS leadership teams in UM Modernization, Value Creation and Business Standardization. This role will be a critical part of the UCS leadership team and will hold delegate decision making authority on behalf of the Chief Medical Officer of UnitedHealthcare. The 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. For all hires within 30 minutes of an office in Minnesota or Washington, D.C., you'll be required to work a minimum of four days per week in-office.

Primary Responsibilities:

• Utilization review, risk management and quality assurance of Utilization Management medical programs in order to ensure the judicious use of the facility's resources and high-quality care
• Comprehensive utilization review containing three types of assessments: prospective, concurrent and retrospective
• Lead UM review team (Clinical Assessment Review Experts) to help validate operational and clinical excellence across the UM continuum
• Collaborate with Network Enterprise and steer National UM Clinical strategy for provider contractual negotiations
• Responsible for developing and executing the clinical strategy and programs to maximize health care quality
• Analyze the company's health care claims data, medical literature, clinical experience and customer feedback to identify future programs
• Accountable for post-deployment measurement of results
• Demonstrate the ability to envision creative, workable solutions
• Quantitative analysis and evaluation of data sets and/or development of research methods to evaluate a problem and recommend data driven solutions
• Establish the financial viability of programs; recommend changes as applicable
• Articulate and represent both UHC and Optum's strategy to executive leaders across the enterprise and external partners
• Communicate with executives in decision-making, program management and initiative implementation
• Make recommendations to improve current processes and coordinate organizational procedures for optimized efficiency and productivity
• Build and develop relationships across teams to ensure effective feedback loops and that deliverables are met
• Advise leadership on improvement opportunities regarding medical expense programs and clinical activities that impact medical expense

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:

• Licensed; Active Board Certification
• ABMS specialty preferred
• 10+ years clinical practice experience inclusive of managed care experience
• Extensive experience in creating and leading UM Programs on either the plan and/or provider setting at a national level
• Experience using evidence-based guidelines, including InterQual
• Deep bench with national experience with a track record of designing, implementing, executing and reviewing Medical Management programs
• Extensive record of performance, by meeting and exceeding operational goals in health care quality and cost management
• Proven success in change management and innovation
• Proficiency in working in a matrix environment
• Strategic thinking with proven ability to communicate a vision and drive results
• Data analysis and interpretation skills
• Ability to focus on key metrics
• Demonstrated ability to make strategic, operational and administrative decisions in response to emerging conditions and environmental circumstances
• Proven ability to drive, lead and communicate change effectively in a fast-paced environment and be adaptable within the changing environment
• Ability to provide recommendations and insight regarding improvements to internal and external processes
• Ability to manage programs and projects in a strategic and professional manner
• Ability to manage and support organizational change and help assist individuals through the transition
• Solid ability to communicate effectively and efficiently (both verbal and written) at multiple levels of large, complex organizations
• Motivate and influence others at all levels within the organization
• Demonstrated ability in systems thinking and enterprise insight to solve complex business problems and solid analytical skills with ability to drive transformational, consumer-centric change and manage long-term programs

*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 $350,000 to $450,000 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.