Medical Director - UnitedHealthcare Community & State; Wisconsin Milwaukee, WI | Remote

Chief Medical Officer For United Healthcare Community & State Wisconsin

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 for United Healthcare Community & State Wisconsin is an important clinical leadership role focused on improving quality, supporting thoughtful medical decision-making, and enhancing the member and provider experience across Medicaid, D-SNP, and LTC populations.

Working closely with the Director of Clinical Operations and cross-functional partners, this role offers the opportunity to shape utilization management, quality improvement, provider collaboration, and population health efforts while helping ensure alignment with the Wisconsin DHS and Forward Health requirements and applicable state and federal regulations.

Reporting Structure

• Reports to:
  
  Chief Executive Officer, Community & State Wisconsin
• Works closely with:
  Clinical, Quality, Population Health, Provider Engagement, and Operations leaders

If you are located in Wisconsin, you will have the flexibility to work remotely
* as you take on some tough challenges.

Primary Responsibilities:

• Provide clinical leadership for utilization management, prior authorization, appeals and grievances, and provider quality activities across Wisconsin Medicaid, LTC, and D-SNP populations
• Support timely, evidence-based coverage decisions aligned with clinical guidelines, plan policies, and regulatory expectations
• Partner with United Clinical Services and enterprise teams to support regulatory changes and strengthen clinical operations
• Participate in clinical rounds, conduct peer-to-peer reviews, and represent the health plan in Medicaid fair hearings as appropriate
• Review all member and provider appeals and grievances and provide clinical information and leadership to the weekly Appeals Panel Hearing calls
• Contribute to performance goals related to HEDIS, STAR Ratings, CAHPS, and NPS
• Identify care gaps and help advance evidence-based interventions that improve clinical quality and member outcomes
• Participate in peer review activities, including Quality of Care and Quality of Service evaluations
• Provide clinical leadership during interdisciplinary rounds and support evidence-based standards of care
• Promote evidence-based practice and standardized clinical approaches that support high-quality care
• Engage network providers to address care gaps, support quality improvement, and encourage evidence-based practice
• Build strong relationships with provider organizations, health systems, and community partners to support quality, utilization, and member experience goals
• Work closely with the Wisconsin Department of Health Services (DHS), including close collaboration with the DHS Chief Medical Officer and the Chief Medical Officers of other Wisconsin Medicaid HMO Plans on statewide quality and performance initiatives
• Apply knowledge of Wisconsin DHS and Forward Health requirements and applicable state and federal Medicaid regulations to support compliant clinical operations
• Support implementation of policy and process changes that enhance clinical programs and operations
• Help reduce unwarranted variation in care through provider education, engagement, and best practices

Leadership Expectations

• Partner with the Chief Executive Officer and plan leadership to help advance clinical strategies aligned with market, regulatory, and organizational priorities
• Support development and execution of care models that improve outcomes and member experience
• Mentor and support clinical and operational colleagues to encourage growth, collaboration, and strong performance
• Help foster a culture of accountability, collaboration, and continuous improvement
• Bring clinical insight into care management, population health, and quality improvement initiatives
• Contribute to strategic planning, program development, and operational priorities

Core Competencies

• Solid clinical leadership and sound medical judgment
• Knowledge of Medicaid and Wisconsin Forward Health regulatory requirements
• Experience with utilization management and medical decision-making
• Commitment to quality improvement and population health outcomes
• Ability to build strong provider and partner relationships
• Collaborative leadership across cross-functional teams
• Strategic thinking with strong operational follow-through

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:

• MD or DO with an active, unrestricted Wisconsin medical license
• Active/unrestricted Board certification in an ABMS/AOBMS…