Chief Medical Officer - Community & State

Improve the lives of others while Caring. Connecting. Growing together.

Job Description
- United Healthcare
- Chief Medical Officer
- Community & State (2369021)

United Healthcare
- Chief Medical Officer
- Community & State - 2369021

At United Healthcare, 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
.

The Chief Medical Officer (CMO), Medicaid (Community & State), is the senior clinical executive accountable for enterprise clinical strategy, medical oversight and performance outcomes across the Medicaid portfolio. The CMO reports directly to the Chief Clinical Officer of United Clinical Services (UCS) and has a dotted line (indirect) reporting relationship to the CEO of Community & State. The CMO sets the clinical vision, drives measurable improvement in quality, equity, access and affordability, and ensures disciplined execution through a national, matrixed organization spanning health plans, shared services and Optum partners.

You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Hybrid in MN/DC:
This position follows a hybrid schedule with four in-office days per week.

Primary Responsibilities:

Clinical strategy & product clinical model: In collaboration with the Community & State leadership team, drives the end-to-end clinical strategy and Medicaid clinical model across Community & State, ensuring competitiveness, compliance, operational efficiency and affordability; establishes governance and a disciplined operating cadence across markets and shared services

Program design, measurement & scaling: Use data-driven insight to identify opportunity areas; design and scale evidence-based clinical programs; collaborate with UCS clinical leaders and Clinical Program Review (CPR) to define KPIs and outcomes measures; conduct regular deep dives to enhance high-performing programs and redesign/retire those that do not meet expectations. Ensure programs leverage common clinical data model whenever possible to enable consistent analysis, modeling and trend prediction at an enterprise level

Affordability & trend management: Partner with Healthcare Economics and UCS to set affordability targets; understand medical/pharmacy trend drivers; build and govern a pipeline of affordability initiatives; monitor progress and adjust strategies to achieve commitments. Maintain an active initiative pipeline, and hold markets, shared services and delegates accountable for results

Market enablement & clinical integration: Partner with market CEOs and CMOs, United Healthcare Networks and business leaders to adapt strategy to state requirements and local delivery models; support the evolution toward more integrated, value-based and incented models of care

Quality, equity & member/provider experience: Drives initiatives to meet or exceed state and federal performance requirements, including HEDIS and CAHPS measures and applicable accreditation standards; drive measurable improvement in quality, equity, access and experience

Regulatory engagement & advocacy: In partnership with the Community & State CEO, Legal and Regulatory Affairs, develop and execute proactive advocacy and relationship strategies with CMS, state Medicaid leadership and policymakers

Utilization management & medical oversight: Provide executive oversight to ensure clinically sound and compliant medical policies, clinical benefits, utilization management and appeals and grievance practices across delegated and shared-service partners. Ensure all state-specific benefit designs, quality metrics and UM criteria are incorporated into clinical programs

Growth enablement (RFPs/procurements): Support Medicaid procurement and growth by articulating the clinical model, value proposition and outcomes; inform solution design to meet regulator, provider and member expectations

Capital stewardship &…