Chief Medical Officer - UCS Clinical Assessment Review Expert

Chief Medical Officer Of United Clinical Services (UCS) Clinical Assessment Review Expert (CAREs) Team

At UnitedHealthcare, 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.

The Chief Medical Officer of United Clinical Services (UCS) Clinical Assessment Review Expert (CAREs) team plays a pivotal role in ensuring UnitedHealthcare's national clinical programs meet key objectives across clinical quality, growth, and financial performance. This position requires a visionary, innovative, and hands-on clinical and operational leader with national executive presence-someone who is client-savvy and thrives on optimizing the value of clinical programs, particularly those related to Utilization Management (UM) activities sponsored by the Lines of Business. Reporting directly to the National Chief Medical Officer of Medical Management, this executive serves as a strategic business partner, leveraging clinical assets to drive high performance in quality, compliance, affordability, and satisfaction across clients, patients, and providers.

You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities :

• Serve as an executive leader within Office of Medical Management within UCS with accountability over the CARES team, including executive strategic vision and leadership across all key operations
• Manage a team responsible for monitoring clinical, affordability, and operational outcomes
• Provide strategic leadership in collaboration with operations, Medical Management pillar leads, Healthcare Economics - medical informatics, finance, network and other key matrixed Line of Business (LOB) partners through all phases of relevant UM programs, including Inpatient Concurrent Review, Prior Authorization, and Medical Claims Review as distinct examples
• Work in partnership with enterprise operational, LOB partners, and Value Creation leadership to address gaps & deficiencies for existing clinical programs, as well as helping to inform clinical value for future medical management initiatives
• Support the organization in identifying emerging clinical trends and shaping strategic direction. Collaborate with internal and external partners to publish high impact content focused on improving compliance, quality, and affordability
• Evaluate clinical and other data (e.g., quality metrics, claims data, bed-day data, usage data) to identify opportunities for improvement of clinical processes
• Develop key messages and talking points for communicating clinical program outcomes to key external stakeholders
• Proactively identify growth opportunities and deliver clinical support to Utilization Management teams, credentialing functions, and delegated entities. Create and maintain strong relationships with key clinical leaders across Optum, UHG, and external delegates
• Participate in and lead key executive meetings including LOB affordability leadership meetings, Value Creation Ideation Front door, and LOB Joint Operating Committee
• Effectively navigate challenging conversations with professionalism and emotional intelligence, particularly when addressing programs that impact compliance, quality, affordability, or involve areas of disagreement. Present clinical findings, remediation strategies, and anticipated outcomes to groups in a clear and impactful manner. Influence development of technical / clinical communications that will be delivered to external audiences (e.g., new clinical policies, programs, processes)
• Discuss oversight findings with internal or external parties (e.g., case managers, other medical directors, clinical providers, physicians)
• Provide feedback to team members and other departments to refine decision making and promote a shared understanding of clinical determinations and outcomes
• Assess and interpret complex financial and clinical data to evaluate feasibility of proposed initiatives
• Identify and implement development resources aligned with evolving business needs and regulatory requirements. Serve as a dyad partner with the Vice-President of Clinical Strategy and Operations within Medical Management.
• Serve as a delegate to the National CMO of Medical Management for broader strategic decisions

Required Qualifications :

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $196,600 to $337,100 annually based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.