Chief Medical Officer - UHC Community Plan of Tennessee - Nashville, TN - Relo Avail
Are you ready to seize this opportunity to do your greatest work as a physician by leading teams to help Tennessee’s most vulnerable population lead healthier and happier lives? UnitedHealthcare 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 Tennessee. 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 UnitedHealthcare Community plan of Tennessee.
This Community and State (C&S) Health Plan serves over half a million Tennesseans receiving Medicaid benefits. The CMO role is accountable for ensuring these Tennesseans 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 Tennessee’s TennCare programs for its managed Medicaid Program. Activities support national, regional and local business goals tailored for the Tennessee Medicaid market.
- 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 Bureau of TennCare’s clinical leadership team, ECS operations teams and with UnitedHealthcare’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), Tennessee 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 TennCare, as well as participating in or leading the regional UHC Peer Review committee.
- Clinical Excellence - The Tennessee 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 TennCare 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 Tennessee 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 collaborative. The CMO will work collaboratively in these activities with ongoing ECS initiatives under the aegis of ECS Regional CMO. The Plan CMO will be the outward face to State regulators based upon Contract requirements and direction of Plan President. The CMO provides clinical thought leadership with external entities, to include TennCare.
- Innovation - The Plan CMO leads the clinical interface with care providers and UHC network management colleagues in efforts to transform the health system. Primary local responsibility is to drive PCCM/Accountable Care Community (Tennessee’s Patient Centered Medical Home) growth through identification of appropriate practices; initial contact and target setting, and Implementation, as well as ongoing leadership during regular Joint Operating Committees (JOCs.) CMO is accountable for oversight of the entire clinical model (end to end) within the market. Knowledge of VBP contracting variants for Medicaid is an essential secondary responsibility that includes but not limited to, UHC’s Accountable Care Platform, clinical practice transformation, patient-centered medical homes, accountable care organizations, creative care management programs, high-performance networks and network optimization, and consumer engagement. Knowledge of and dedication to developing and improving an integrated service clinical model (medical, behavioral, and social risk) is required. The CMO must also create a culture of diversity and inclusion, with supporting programs targeted to reduce health disparity.
- Growth – The CMO delivers the clinical value proposition focused on quality, affordability, and service, in support of growth activities of the C&S Health Plan. The CMO reviews and edits communication materials as required and represents the voice of the market-based customer in program design. CMO contributes to any RFP/re-procurement activity in the state. The Plan CMO actively promotes positive relations with State/local regulatory authorities and Medical Societies and records.
- Grievance and Appeals - The Plan CMO maintains an active liaison with ECS Grievance & Appeals and is responsible for leading a clinical team overseeing and or representing the Local C&S plan at state-level fair hearings at the state’s request. This work is integrated with the health plan operations team by providing leadership in evaluating both requests from the State for Independent Reviews and formal Provider Complaints.
Demonstrable Skills and Experience:
- Ability to build a team that values organizational and health plan success over personal success; provide ongoing coaching and feedback to ensure peak performance; identify and invest in high potentials; actively manage underperformance
- Ability to focus staff on the company's mission; inspire superior performance; ensure understanding of strategic context; set clear performance goals; focus energy on serving the customer; provide ongoing communication to the team; discontinue non-critical efforts
- Ability to drive disciplined fact-based decisions
- Ability to execute with discipline and urgency; drive exceptional performance; 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. CMO is a leadership position within the health plan, a part of the “C” Suite, a skilled General Manager with a clinical expertise
- Ability to 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 model and demand integrity and compliance
- Proven ability to execute and drive improvements against stated goals
- Ability to develop relationships with Tennessee State government clinical leadership, network and community physicians and other providers
- Ability to be visible and be involved in medical community
- Ability to successfully function in a matrix organization exhibiting the culture of United Health Group
CMO Leadership Expectations:
- Deliver value to members by optimizing the member experience and maximizing member growth and retention
- Lead and influence Health Plan employees by fostering teamwork and collaboration, driving employee engagement, and leveraging diversity and inclusion
- Develop and mentor others while also building awareness to your own strengths and development needs
- Influence and negotiate effectively to arrive at win-win solutions
- Communicate and present effectively, listen actively and attentively to others, and convey genuine interest
- Lead change and innovation by demonstrating emotional resilience, managing change by proactively communicating the case for change and promoting a culture that thrives on change
- Play an active role in implementing innovative solutions by challenging the status quo and encouraging others to do so
- Drive sound and disciplined decisions that drive action while effectively using financial knowledge and data to manage the business
- Drive high-quality execution and operational excellence by communicating clear directions and expectations
- Manage execution by delegating work to maximize productivity, exceed goals and improve performance
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.
- Active and unrestricted Tennessee medical license as a Doctor of Medicine (MD) or Doctor of Osteopathy (DO)
- Board Certified in one or more of Internal Medicine, Family Medicine, Pediatrics, OB/GYN, or Psychiatry
- Current DEA licensure and prescriptive authority in the state where applicable
- 5+ years of clinical practice experience
- 2+ years of Quality Management experience
- Solid knowledge of managed care industry and the Medicaid line of business, including Utilization Management
- Reside in the greater Nashville, Tennessee area
- Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation.
- Master’s degrees in public health, business administration and or HealthCare Administration
- Familiarity with current medical issues and practices
- 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
- Solid team player and team building skills
- Strategic thinking with proven ability to communicate a vision and drive results
- Solid negotiation and conflict management skills
- Proficiency with Microsoft Office applications
- Creative problem-solving skills
- Solid leadership skills, as demonstrated by continuously improved results, team building, and effectiveness in a highly matrixed organization
- Excellent interpersonal communication skills
- Excellent project management skills
To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment
Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low- income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.(sm)
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.