CMO - Community Plan | NY | Remote

Chief Medical Officer

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 equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

This is a rare opportunity to lead clinical strategy and performance for one of the largest and most complex Medicaid health plans in the country. The Chief Medical Officer (CMO) will shape how care is delivered to hundreds of thousands of New Yorkers, with direct accountability for medical cost trends, quality outcomes, and value-based provider performance.

The CMO is the senior clinical executive for United Healthcare Community Plan of New York and a key member of the executive leadership team. This role owns the clinical performance of the health plan, including total cost of care, quality, provider results, and clinical relationships with New York State.

This is a true operating role. Success requires a physician leader who can translate data into action, influence providers and internal partners, and deliver measurable performance improvement at scale across a complex, matrixed organization.

If you are NY state based, you will have the flexibility to work remotely
* as you take on some tough challenges.

• Medical cost management and affordability
  • Own and lead the clinical strategy to improve medical cost trend across all lines of business
  • Identify the highest impact drivers of cost, including inpatient, outpatient, emergency department, post-acute, and pharmacy spend
  • Use data and analytics to identify actionable trends, prioritize interventions, measure outcomes, and drive fact-based decision making
  • Partner with internal and external stakeholders to implement clinical programs that reduce unnecessary utilization and improve care delivery
  • Deliver clinical and financial performance, including total cost of care, quality incentive capture, and improvement in documentation and risk capture
• Quality and clinical performance
  • Partner with quality leadership to improve performance on HEDIS, P4P measures, CAHPS, and other key quality indicators
  • Translate quality priorities to convert performance gaps into actionable provider and operational strategies
  • Support accreditation readiness and sustained clinical excellence
  • Ensure alignment between affordability initiatives and quality outcomes
• Provider partnership and value-based care
  • Drive provider performance in cost and quality through data transparency, clinical engagement, and value-based partnerships
  • Partner with network leadership and UHN to expand and strengthen value-based care models
  • Lead high impact engagements with hospitals, FQHCs, ACOs, large physician groups, health homes, and other priority partners.
  • Influence physician behavior and clinical workflows to improve outcomes, utilization, and member experience
• Regulatory and state clinical leadership
  • Maintain strong working knowledge of New York Medicaid managed care requirements and ensure compliant clinical oversight.
  • Build trusted relationships with state clinical leadership and represent the health plan credibly in clinical discussions with regulators and external stakeholders
  • Provide clinical oversight of medical necessity determinations, appeals/fair hearing clinical issues, and other physician-level governance responsibilities as required
• Clinical governance and matrix leadership
  • Chair the Quality Improvement Committee and lead clinical governance across the organization
  • Ensure solid oversight of clinical policies, guidelines, and standards of care
  • Partner closely with the Health Services Director and clinical operations leadership to triage issues, remove barriers, strengthen execution, and maintain regulatory readiness
  • Lead through influence in a matrixed environment and establish clear accountability and alignment around clinical priorities and performance outcomes
• Population health and innovation
  • Advance population health strategies to improve outcomes for complex Medicaid…