NORTH CAROLINA COMMUNITY AND STATE CHIEF MEDICAL OFFICER

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 equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.  The C&S Plan Chief Medical Officer has accountability for ensuring that local health plan, United Clinical Services and UHC initiatives focusing on clinical excellence, quality ratings improvement, appropriate inpatient and outpatient utilization, health care affordability, health system transformation including provider network issues, mandated provisions and compliance, growth and focused improvement are implemented and successfully managed to achieve goals. This position reports to the local C&S plan President and has dotted line relationships to the C&S Chief Medical Officer and UCS market-assigned Regional Chief Medical Officer. The C&S Plan CMO’s primary responsibilities are directed towards C&S plan activities as defined by the C&S plan CEO, also collaborates with United Clinical Services (UCS) staff including the regional Chief Medical Officer, and other market and regional matrix partners to implement programs to support and meet market C&S, UCS/ UHC and line of business goals.If you reside in NC, you will have the flexibility to work remotely* as you take on some tough challenges.Primary Responsibilities: Quality and Affordability - The Plan CMO has primary responsibility and accountability for Total Medical PMPM performance and targets for the local C&S plan. This will require a close working relationship with UCS clinical operations teams as well as with the C&S and UCS national affordability team. Activities will include conducting hospital Joint Operations Committee meetings with Network, contributing to-and implementing-regional Medical Cost Operating Team (MCOT) decisions, data sharing with physicians and physician groups on quality and efficiency improvement opportunities, and implementing local Health Care Affordability Initiatives.  The Medical director will serve as clinical lead for healthcare affordability initiatives at the local market and establishing a process for sharing data with hospitals and physicians and completing peer to peer communications as required. Additionally, the Plan CMO has primary responsibility to oversee new clinical model operations including ACC Accountable Care Community relationships, Target setting JOC leadership. Support UHN initiatives and Quality Affordability Programs as required to achieve the appropriate inpatient and outpatient utilization and affordability goals of the C&S Health Plan and United Clinical Services/ UHC. The Plan CMO has oversight responsibility of the C&S market peer review process as defined by State regulator as well as participating in or leading the Peer Review committee.Clinical Excellence - The C&S plan CMO works closely with the Health Services VP and Health Plan Quality Director and supports the HEDIS data collection process, STARs clinical collection process, CAHPS improvement, and drive Health Plan accreditation activities as well as quality rating initiatives for the local C&S plan. Acts as an improvement catalyst for all quality-related efforts including Center for Medicare and Medicaid Services Star initiatives.  Communicate to providers on new focus and measure/process changes.  Supports all Clinical Quality initiatives and peer review processes including Quality of Care and Quality of Service issues.Relationship Equity and State Compliance - The Plan CMO maintains a solid 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.  S/he also is committed to being effectively 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 CMO will work collaboratively in these activities with ongoing UCS initiatives under the aegis of UCS Regional CMO. The Plan CMO will be the outward face to State regulators based upon Contract, and direction of Plan President and C&S CMOInnovation - The Plan CMO leads the clinical interface with care providers and UHC network management colleagues in efforts to transform the health system. Primary local responsibility is to drive AMH Performance through identification of appropriate practices; initial contact and target setting, and Implementation, as well as ongoing leadership of monthly JOCs. Knowledge of Value Based contracting variants for C&S will be essential Secondary responsibility will include but not limited to, UHC’s Accountable Care Platform, clinical practice transformation, patient-centered medical homes, accountable care organizations, creative care management programs, high-performance networks and network optimization, and consumer engagement Growth - This medical director delivers the clinical value proposition focused on quality, affordability, and service, in support   of growth activities of the C&S Health Plan and the plan CMO reviews and edits communications materials as required and represents the voice of the market-based customer in program design.  The Plan CMO actively promotes positive relations and advocacy with State/local regulatory authorities and Medical Societies and records such in PEI toolFocused Improvement - The Plan CMO is responsible for identifying opportunities through participation in regional and local Medical Cost Operating Teams or Market reviews, National MCOT. S/he actively participates in Joint Operating Committees/Business Reviews.  S/he also provides local feedback on, and oversight of the performance Optum Behavioral Solutions and Optum Health as needed.   Additional responsibilities include the timely collection and entry of information into Online Engagement Survey tools and scorecards; developing action plans for sub-optimal results; and taking a leadership role in Quality Affordability Programs initiativesGrievance and Appeals - the Plan CMO maintains an active liaison with UCS G&A and is responsible for representing the Local C&S plan at State Fair HearingsDemonstrable Skills and Experiences:Ability to build a team that values organizational and Plan success over personal success; provide ongoing coaching and feedback to ensure peak performance; identify and invest in high potentials, actively manage underperformanceFocus staff on the company's mission; 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 effortsDrive disciplined fact-based decisionsExecute 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 resultsDrive change and innovation though continually seeking and implementing innovative solutions; create a culture that thrives on continuous change; inspire people to stretch beyond their comfort zone; take well-reasoned risk; challenge the way it has always been done; change direction as requiredModel and demand integrity and complianceProven ability to execute and drive improvements against stated goalsAbility to develop relationships with network and community physicians and other providersVisibility and involvement in medical communityAbility to successfully function in a matrix organizationLeadership Expectations:Deliver value to members by optimizing the member experience and maximizing member growth and retention                                      Lead and influence Health Plan employees by fostering teamwork and collaboration, driving employee engagement, and leveraging diversity and inclusionDevelop and mentor others while also building awareness to your own strengths and development needsInfluence and negotiate effectively to arrive at win-win solutionsCommunicate and present effectively, listen actively and attentively to others, and convey genuine interestLead change and innovation by demonstrating emotional resilience, managing change by proactively communicating the case for change and promoting a culture that thrives on changePlay an active role in implementing innovation solutions by challenging the status quo and encouraging others to do soDrive sound and disciplined decisions that drive action while effectively using financial knowledge and data to manage the businessDrive high-quality execution and operational excellence by communicating clear directions and expectationsManage execution by delegating work to maximize productivity, exceed goals and improve performanceExcellent interpersonal communication skillsCreative problem-solving skillsSolid team player and team building skillsStrategic thinking with proven ability to communicate a vision and drive resultsYou’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 North Carolina Medical License Active/unrestricted Board Certification in internal medicine, family medicine, pediatrics, psychiatry, OB/GYN and/or emergency medicine5+ years of clinical practice experienceExperience in Value Based Contracting / Risk contractingSolid knowledge of managed care industry and the Medicaid line of businessFamiliarity with current medical issues and practicesProficiency with Microsoft Office applications Proven ability to develop relationships with network and community physicians and other providersProven ability to focus on key metrics Proven superior presentation skills for both clinical and non-clinical audiencesDemonstrated excellent project management skillsProven solid data analysis and interpretation skillsDemonstrated negotiation and conflict management skillsResides in North Carolina and available for routine, in-person contact with market-teams, network providers, stakeholders, and regulatorsPreferred Qualifications:Demonstrated experience with behavioral health delivery, SUD treatment, child welfare, pharmacy management and related regulatory areas (ex. Parity)Experience with UHC and/or Optum clinical operations and medical leadershipDemonstrated knowledge and professional experience with Medicaid managed care*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy 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.  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.Brand: Community & StateJob ID: 2227705Employment Type: Full-timeJob Area: Medical & Clinical OperationsFunction: GeneralIndustry: Direct Health/Medical Insurance Carrier