Community & State Health Plan Chief Medical Officer - Georgia
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The C&S Plan Chief Medical Officer has accountability for ensuring that local health plan, Enterprise Clinical Services (ECS) and UnitedHealthcare (UHC) initiatives focusing on clinical excellence, quality improvement, appropriate inpatient and outpatient utilization, affordability, health system transformation including provider network, compliance with regulatory mandates, growth and other focused improvements are implemented and successfully managed to achieve goals. This position reports to the Georgia C&S health plan Chief Executive Officer and has a dotted line relationship to the C&S Chief Medical Officer. The Georgia C&S Plan CMO’s primary responsibilities are directed towards C&S plan activities as defined by the C&S plan CEO and, also collaborates with Enterprise Clinical Services (ECS) staff including local and regional Chief Medical Officers, and other market and regional matrix partners to implement programs to support and meet C&S health plan, C&S line of business, ECS and UHC goals.
- Quality and Affordability – The Plan CMO has primary responsibility and accountability for Total Medical PMPM performance and targets for the local C&S plan. This will require a close working relationship with ECS clinical operations teams, Optum Behavioral Solutions, Optum Transplant, Optum Neonatal Resource Solutions and other internal clinical vendors, as well as with the C&S and ECS national affordability teams. Activities will include responsibility to oversee new clinical model operations including PCMH and Accountable Care Organization (ACO) relationships, and new Models of Care such as those defined by CMS. Additional responsibilities include conducting hospital Joint Operations Committee meetings with prioritized providers in coordination with UnitedHealth Network (UHN) and ECS, data sharing with physicians and physician groups on quality and efficiency improvement opportunities, completing peer to peer communications as required, and implementing local and national Health Care Affordability Initiatives in order to achieve inpatient and outpatient utilization and affordability goals
- Clinical Excellence – The C&S plan CMO helps oversee the HEDIS and CMS Stars data collection process and local performance strategy, CAHPS improvement strategy, and drives Health Plan accreditation activities as well as quality rating improvement initiatives and other clinical interventions for the local C&S plan. The CMO is responsible for achievement of goals for contractually required clinical Quality Performance Indicators and state regulator-driven pay-for-quality initiatives. The CMO oversees market peer review processes including Quality of Care and Quality of Service issues, and leads the Physician Advisory Committee (PAC), Quality Management Committee (QMC) and other associated committees
- Relationship Equity and State Compliance - The Plan CMO maintains a solid working knowledge of all government mandates and provisions for the local C&S market, as well as working across the enterprise to implement and maintain compliant clinical programs and procedures. S/he also is committed to being effectively engaged with our external constituents such as consumers/members, physicians, medical and specialty societies, hospitals and hospital associations, federal/state regulators, and market-based collaboratives. The C&S plan CMO will work collaboratively in these activities with the ECS local and regional CMOs. The Plan CMO will be the outward face to State regulators based upon Contract, and direction of Plan CEO and C&S CMO and should provide clinical thought leadership with external entities and the state
- Innovation—The Plan CMO leads the clinical interface with care providers and UHN (network management) colleagues in efforts to transform the health system. Primary local responsibility includes driving PCMH and ACO growth through identification of appropriate practices; initial contact and target setting, and Implementation, as well as ongoing leadership during monthly JOCs. CMO is accountable for oversight of the entire clinical model (end to end) within the market. Knowledge of alternative payment model variants for C&S will be essential. Secondary responsibility will include 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
- Growth – This CMO delivers the clinical value proposition focused on quality, affordability and service, in support of growth activities of the C&S Health Plan. The plan CMO reviews and edits communications 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
- Focused Improvement –The Plan CMO is responsible for identifying opportunities through participation in regional and local Market reviews, and healthcare economics analyses. S/he actively participates in various Joint Operating Committees. S/he also provides oversight of the performance of Enterprise Clinical Services including the Inpatient Care Management team and Clinical Coverage Review team (prior authorization), Appeals and Grievances, Optum Behavioral Solutions, Optum Physical Health, OptumRx and other OptumHealth teams
- Grievances and Appeals- the Plan CMO maintains an active liaison with UnitedHealth A&G and is responsible for representing the Local C&S plan at State-level Fair Hearings
Demonstrable Skills and Experiences:
- Proven ability to execute and drive improvements against stated goals. Drive disciplined fact-based decisions through effective use of financial knowledge and data
- 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; identify and invest in high-potential colleagues; actively manage underperformance
- 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
- Influence and negotiate effectively to arrive at win-win solutions
- Communicate expectations and present effectively, listen actively and attentively to others, and convey genuine interest
- Execute with discipline and urgency: Drive exceptional performance; deliver value to the customer; closely monitor execution; drive operational excellence; get directly involved when needed and delegate work to maximize productivity; 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
- 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
- Model and demand integrity and compliance
- Has a positive, flexible, and informed account management approach when working with members of the Georgia Department of Community Health
- Visibility and involvement in medical community
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/unrestricted Georgia Licensed Physician
- Active/unrestricted Board Certification in an ABMS or AOBMS specialty
- 5+ years of clinical practice experience; solid knowledge of managed care industry and the Medicaid line of business
- 2+ years of quality management experience
- Demonstrated familiarity with current medical issues and practices
- Solid leadership skills, as demonstrated by continuously improved results, team building, and effectiveness in a highly matrixed organization
- Proven excellent interpersonal communication skills
- Demonstrated superior presentation skills for both clinical and non-clinical audiences
- Ability to develop relationships with network and community physicians and other providers
- Proven excellent project management skills
- Solid data analysis and interpretation skills; ability to focus on key metrics
- Solid team player and team building skills
- Demonstrated 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
- 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
To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies now require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles require full COVID-19 vaccination 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)
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
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.