C&S Plan of Kentucky - Chief Medical Officer

Position Overview

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

The Community & State Plan of Kentucky Chief Medical Officer (CMO) will use their proven track record to become the end-to-end owner of the clinical, quality and value-based provider leadership and financial outcomes. This role oversees all health plan product clinical offerings, clinical market strategies, Shared Services clinical team collaboration, clinical data analysis to improve outcomes, new program implementations, quality standard initiatives, and compliance with state Medicaid requirements, while driving value-based initiatives through clinical and vendor organizations. The position also manages clinical relationships with state clients and key clinical leaders across the Commonwealth of Kentucky.

You'll be rewarded and recognized for your performance in an environment that challenges you and provides clear direction on success, along with development opportunities for advancing your career.

Key Responsibilities

• Oversight of clinical processes and policy decisions to ensure that optimal and cost-effective medical care is provided following accepted guidelines and protocols.
• Development, implementation, and oversight of the population health strategy to drive strategic clinical leadership and innovation.
• Serve as chairman of the Health Plan's Quality Improvement Committee (QIC).
• Drive financial oversight to improve affordability related to medical and pharmacy spending, enhance capture of state-level quality-based incentive dollars, and optimize provider documentation and diagnosis.
• Ensure delivery of services at the highest quality standards by overseeing initiatives designed to meet or exceed HEDIS and accreditation standards.
• Develop strong collaborative partnerships across a matrixed organization, including local Market leadership, functional VPs, Market CMOs, health plan CEOs, and Executive Directors across various business lines.
• Continuously improve HEDIS and CAHPS scores for both members and providers.
• Provide guidance to physicians and nurses on aspects of medical care and multi-level transitions of care, including referrals and quality-of-care concerns.
• Review inpatient cases where applicable to ensure successful bed-day management in line with company goals.
• Analyze utilization data to identify trends and opportunities for process improvement in inpatient and outpatient settings.
• Act as a clinical subject matter expert for needs assessment, design, implementation, and evaluation of clinical programs supporting growth and affordability.
• Cultivate and sustain strong relationships with stakeholders to influence program design, garner support, secure approvals, and foster collaboration.
• Contribute to senior medical management strategy development and ensure regulatory compliance and adherence to best practice standards.
• Educate physicians and nurses on effective management of Health Plan benefits and medical services to appropriately meet member needs.
• Oversee the development and revision of clinical care standards, practice guidelines, and protocols for the Health Plan.

Required Qualifications

• Active/unrestricted Kentucky M.D/D.O. License
• Active Board Certification
• Kentucky resident or willing to relocate to Kentucky
• 5+ years of direct patient-facing clinical work
• 5+ years of progressively responsible management experience in a managed care setting or a large health-system/clinically integrated network focused on population health leadership
• Broad and comprehensive knowledge of medical management principles and insurance products across multiple lines of business in a managed care environment
• Solid knowledge of Population Health, the community health care environment, the provider network, and managed care contracting processes
• Good understanding of managed care systems, quality improvement, and risk management
• Demonstrated ability to drive performance across a matrixed environment

Preferred Qualifications

• Solid clinical foundation in primary care (preferably) or subspecialty care (Board Certification is an absolute requirement)
• Keen insight into the health care delivery system and the relationships among MCOs, hospitals, physicians, and ancillary services
• Solid understanding of Long-Term Support Service Programs
• Experience with Value Based Care, Physical/Behavioral Health Integration, HEDIS, and NCQA Accreditation
• Demonstrated ability to think strategically at a high level and set a clinical vision for the organization
• Excellent verbal and written communication skills, with the ability to present confidently and persuasively
• Ability to work effectively in a matrixed organization, influencing others to achieve health plan goals
• Proven thought leadership at the state regulatory level, particularly in establishing relationships with state CMOs and influencing clinical agendas
• Familiarity with Population Health concepts and evidence of developing at least one Population Health clinical program
• Superior data analytic abilities and an understanding of how various clinical metrics interrelate, especially regarding medical cost trend management
• Exceptional leadership skills characterized by emotional intelligence and empathy