The CMO is the leader of the market level Continuum of Care (COC) ensuring integration of all United Healthcare (UHC), United Clinical Services (UCS) and OPTUM clinical functions to drive incremental reduction in admissions/ readmissions, continuous improvement of HEDIS and STARs ratings, reduction of unnecessary ER visits, and mitigation of provider abrasion from prior authorization and inpatient management programs.
The CMO collaborates with the market CEO, the market Senior Leadership (SLT) team, UCS staff, and matrix partners such as Network, Sales and other market and regional partners to implement and drive programs to support and meet UCS goals for commercial and Medicare lines of business. The CMO reports to the Regional Chief Medical Officer with dotted line accountability to the local market CEO.
• Clinical Continuum – This CMO serves as the market lead of all clinical programs as they impact a member’s passage from enrollment thru end of life care and Hospice. The CMO will hold daily rounds with continuum clinical partners to identify roadblocks, effect resolution, reduce internal and external cycle times, and integrate information flow with providers to reduce admissions/ readmissions. The CMO will produce and present weekly status reports, work plans, and results to the President of United Clinical Services on the performance of the market.
• Quality and Affordability – The CMO has responsibilities for utilization management from a macro view: conducting hospital Joint Operations Committee meetings, contributing to--and implementing--regional Medical Cost Operating Team decisions, bed day action committee meetings with Inpatient Care Management (ICM), data sharing with physicians and physician groups on quality and efficiency improvement opportunities, and implementing local Health Care Affordability Initiatives. At a more micro level, the CMO will drive and manage Market ACO and delegated medical group performance and work with providers to close clinical quality gaps in care for STARs and HEDIS. This focus not only ensures affordability gains but also drives and reinforces the importance of the triple aim with strong emphasis on value realization at the market level which includes quality revenue, risk revenue and medical cost reduction.
• Clinical Excellence – The CMO helps oversee the HEDIS data collection process, CAHPS improvement as the measure of member satisfaction and quality in its broadest definition (QoC, HEDIS, QIPs), and drive Health Plan accreditation activities as well as quality rating initiatives. The CMO acts as an improvement catalyst for all quality-related efforts including CMS Star initiatives. Additionally, the CMO communicates with providers on new focus and measure/process changes and supports all Clinical Quality initiatives and peer review processes including Quality of Care and Quality of Service issues.
• Relationship Equity— The CMO maintains a strong working knowledge of all government mandates and provisions, working across the enterprise to implement and maintain compliant clinical programs and procedures. S/he is engaged in regular, proactive dialogue with our external constituents) in order to continuously improve health care to enrollees and better products for our customers.
• Innovation— This CMO leads the clinical interface with care providers and UHC network management colleagues in efforts to transform the health system, including, but not limited to, UHC’s Accountable Care Platform, value-based contracting, clinical practice transformation, patient-centered medical homes, transparency initiatives such as UnitedHealth Premium® Designation, creative care management programs, high-performance networks, consumer engagement, and value-based benefit designs.
• Growth – This CMO delivers the clinical value proposition focused on quality, affordability and service, in support of the sales and growth activities of the Health Plan including conducting Broker/Client presentations and participating in customer consultations. The CMO reviews and edits communications materials as required and represents the voice of the market-based customer in program design. S/he actively promotes positive relations with State/local regulatory authorities and Medical Societies.
• Focused Improvement – The CMO is responsible for identifying opportunities through participation in regional and local Medical Cost Operating Teams or Market reviews. 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 United Clinical Services and Quality Affordability Programs initiatives.
Demonstrable Skills and Experiences:
• Proven record of executive leadership/clinical management in a hospital system or large practice group.
• Drive 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 required
• Ability to build a team through influence that values organizational success over personal success; drive exceptional performance by provide ongoing coaching and feedback; identify and invest in high potentials; actively manage underperformance.
• Execute with discipline and urgency: 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 results.
• Model and demand integrity and compliance
• Proven ability to execute and drive improvements against stated goals.
• Ability to develop relationships with network and community physicians and other providers.
• Visibility and involvement in medical community.
• Ability to successfully function in a matrix organization.
• Active and unrestricted medical license for the assigned market(s); Board Certified in an ABMS or AOBMS specialty
• 5+ years clinical practice experience; strong knowledge of managed care industry
• Familiarity with current medical issues and practices
• Excellent interpersonal communication skills; ability to influence in executive settings
• Health plan experience preferred
• Strong knowledge of health care utilization data and analytics
• Proven ability to identify an improvement opportunity through data, implement a solution and achieve measurable impact. Metrics driven.
• Ability/experience in developing collaborative relationships with health system clinical leadership
• Strong team orientation, willing to roll up their sleeves and work with all levels within the organization. Can get things done within a matrixed environment and isn’t hung up on who reports to who.
• Works in partnership with the CEO to achieve financial and quality (STARs) goals.
• Knowledge of health plan finance, STARs and accurate coding helpful, but not required.
• Superior presentation skills for both clinical and non-clinical audiences
• Proven ability to develop relationships with network and community physicians and other providers
• Solid data analysis and interpretation skills; ability to focus on key metrics
• Strong team player and team building skills
• Strategic thinking with proven ability to communicate a vision and drive results
• Solid negotiation and conflict management skills
• Creative problem solving skills.
• Proficiency with Microsoft Office applications (Outlook, Word, Excel, PowerPoint)
• Ability to travel within the assigned market
• Advanced Business, Public Health, Medical Management degree is a plus
Careers at UnitedHealthcare Medicare & Retirement.
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