C&S CMO Mexico

Position: C&S CMO New Mexico
Location: Taos

** Requisition number:
** 2376339

** Job category:
** Medical & Clinical Operations

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*
* Are you ready to seize this opportunity to do your greatest work as a physician by leading teams to help New Mexico's most vulnerable population lead healthier and happier lives? United Healthcare is creating opportunities in every corner of the healthcare marketplace to improve lives while building careers.

Innovation isn't about another gadget; it's about transforming the health care industry through integrated clinical models and value-based provider programs that combine to deliver the quadruple aim statewide in New Mexico. That means continuous career growth opportunities for you. While we support you with the latest tools, advanced training, and the combined strength of high caliber co-workers, you can continue following the path of your life's best work.

SM of Chief Medical Officer (CMO) for United Healthcare Community plan of New Mexico.

This Community and State (C&S) Health Plan serves over half a million New Mexicans receiving Medicaid benefits. The CMO role is accountable for ensuring these individuals achieve high quality clinical outcomes as evidenced by exceptional quality performance ratings, as well as high member and provider satisfaction scores. Furthermore, healthcare transformation is a priority focus of the CMO by continuously advancing a clinical model that engages underserved individuals in a population health model that is supported by integrated community care teams and over 3,000 providers in a value-based payment model.

This position reports to the Health Plan's Chief Executive Officer (CEO) and has dotted line relationships to the C&S CMO as well as to the Enterprise Clinical Services (ECS) Regional CMO. The CMO's primary responsibilities are directed towards local C&S plan activities as defined by the Health Plan's CEO. The CMO collaborates with ECS staff including the regional CMO, and other market and regional shared service partners to implement the State of New Mexico's programs for its managed Medicaid Program.

Activities support national, regional, and local business goals tailored for the New Mexico Medicaid market.

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* Primary Responsibilities:

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* + Quality and Affordability - The Health Plan CMO has primary responsibility and accountability for quality medical outcomes and performance while championing healthcare affordability projects that ensure members receive the best possible care. This requires a close working relationship with the State's clinical leadership team, ECS operations teams and with United Healthcare's national healthcare economics team. The CMO serves as the clinical leader for healthcare affordability initiatives in the local market.

Additionally, the CMO is a primary stakeholder in clinical model operations including Person-Centered Care Models (PCCM), New Mexico Delivery System Transformation and Value Based Program (VBP) relationships. This includes the design, collaboration, and implementation of new and or improved Models of Care programs such as those defined by the State contract, by Centers for Medicare and Medicaid Services (CMS). The CMO has oversight responsibility of the local market peer review process as defined by the State, as well as participating in or leading the regional UHC Peer Review committee.

+ Clinical Excellence - The New Mexico Health Plan CMO supports the HEDIS and STARs data collection process, CAHPS improvement strategy, and drives Health Plan accreditation activities. The CMO also ensures strong HEDIS, Stars and State defined performance measures results to support all advanced payment models. The CMO acts as an improvement catalyst for all quality-related efforts including Center for Medicare and Medicaid Services Star initiatives.

Communicates 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; participates or leads Physician Advisory Committees (PAC);
Quality Management Committee (QMC) and other associated quality focused committees.

+ Relationship Equity and State Compliance - The Plan CMO maintains a strong working knowledge of all government mandates and provisions for the New Mexico Medicaid market, as well as working across the enterprise to implement and maintain compliant clinical programs and procedures. The CMO must be effectively engaged with external constituents such as consumers/members, physicians, medical and specialty societies, hospitals and hospital associations, federal/state regulators, and market-based…