Description

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

UnitedHealthcare Employer & Individual (E&I) is hiring a Chief Medical Officer for Surest, its fastest growing employer sponsored health plan. Surest is UnitedHealthcare's flagship, consumer centric benefit innovation, designed to simplify health insurance while improving affordability, engagement, and outcomes. The plan eliminates deductibles and coinsurance, replacing them with clear, upfront copays and a digital first experience that helps members compare options and choose high value providers across UnitedHealthcare's broad, national network. Serving more than 1 million members and approximately 1,300 employers across National and local self-funded, fully insured, and level funded, Surest continues to deliver solid year over year growth. The CMO is a physician executive leader who reports to the Chief Medical Officer & Senior Vice President, UHC E&I Group, Individual and Specialty, and will shape clinical strategy for one of the most innovative and rapidly scaling health plans in the U.S.

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

Primary Responsibilities:

Leadership

• Champion Surest's clinical value proposition in client meetings, differentiating Surest and UHG from competitors
• Serves as the clinical advisor to Surest business leaders, cross functional teams, and clients
• Supports the Surest clinical strategy that differentiates the organization in total cost of care, advocacy, access, clinical outcomes, and growth
• Provides strategic input to quality, clinical programs, affordability, accreditation, compliance, and fraud, waste, and abuse
• Understands, designs, and promotes best practices for clinical and wellness programs in health plans, including case management, utilization management, Centers of Excellence (COE) programs, and wellness initiatives, ensuring these programs are evidence-based, effective, and aligned with organizational goals
• Cultivates a comprehensive understanding of industry and purchaser trends in healthcare benefits delivery, positioning Surest at the forefront of innovation
• Collaborates with UnitedHealth Group stakeholders to advance Surest's mission and drive enterprise growth
• Works with the clinical and cross functional teams to ensure all aspects of clinical strategy at the account/client level are executed and provide oversight and direction for the implementation of clinical programs and strategies
• Manage clinical relationships with UCS, ECS, Optum, and Surest business leaders, including medical and reimbursement policies, clinical analytics, program performance, provider network, and clinical operations
• Supports the business in identifying market trends that should influence key investments
• Presents on population health trends, including analysis of contributors, incidence, and management strategies for high-cost claimants
• Serves as the clinical point of contact for providers, hospital systems, government/state regulatory entities, professional and medical societies
• Represents Surest with external health professionals, state and national professional societies, trade associations, and through speaking opportunities at local and national conferences

Client Engagement Support

• Builds solid client relationships and seeks to understand population health outcomes, drivers, and opportunities for improved health outcomes
• Delivers compelling presentations to a range of stakeholders - including senior executives, benefit managers, providers, and employee populations - highlighting clinical outcomes and industry trends
• Works closely with clinical, operations, sales, marketing, product, account management, healthcare economics, market business and clinical leaders to lead the clinical aspects of the sales and client renewal process
• Presents at finalist and renewal customer meetings, delivering presentations that detail the Surest clinical value proposition that grows and maintains membership and long-term relationships
• Serves as an external expert spokesperson to communicate our clinical value story to audiences including prospective and existing clients, local markets, professional associations, and in other thought leadership events
• Uses a data driven and experiential consultative approach with clients on analytics and assessments
• Meets growth and revenue targets in partnership with Surest leadership

Clinical Operations, Medical Policy and Affordability Support

• Uses data on utilization, cost trends, and new policies to help design targeted affordability initiatives from ideation to deployment, including prior authorization, inpatient utilization and site of service, outpatient management, specialty Rx, high-cost claimants, case and disease management, network optimization, and payment integrity
• Provides clinical guidance to business leaders and clients regarding appropriate utilization that improves outcomes while decreasing costs
• Collaborates with medical policy and pharmacy teams to provide physician input on new technologies, medications, and complex clinical policy issues
• Partners with UCS and other functional partners on additional business priorities as relevant including ad hoc analyses with Medical Economics

Member Support

• Handles client/member escalations in close partnership with strategic account executives, client executive teams, network providers, and clinical operations
• Partners closely with Optum ECS and PHS physicians on any escalations of complex Surest members with urgent needs

Product Support

• Collaborates with product organization and functional partners to continually enhance and quantify the value of existing services and develop new products and solutions to address emerging market opportunities
• Supports the Surest product teams regarding business decisions on benefit design including benefit limits in accordance with ERISA and client specifications
• Reviews clinical marketing materials and provides physician input when needed

Quality Support

• Supports accreditation and compliance and maintains a solid knowledge of all government mandates/provisions, working across business and enterprise functional partners to maintain compliant clinical programs and procedures
• Provides physician input on opportunities to enhance medical/behavioral coordination, ensure mental health parity, improve clinical outcomes and quality performance
• Supports quality improvement efforts and provides physician input into any new quality improvement campaigns
• Participates in response development and delivery to high level questions, concerns and complaints from regulators, accreditors, legal/risk management, clients, healthcare providers, and other stakeholders

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.

Required Qualifications:

• Active/Unrestricted State Licensed Physician
• Board Certified in an ABMS or AOA primary care specialty
• 5+ years clinical practice
• 3+ years in a senior clinical leadership position, preferably with significant client-facing and provider-facing experience
• Experience working with health plan sales
• Experience in population health management
• Solid understanding of Evidence-Based Medicine (EBM) and managed care principles
• Familiarity with current medical issues, and clinical regulatory environments
• Proficiency in Windows-based computer skills including Microsoft Office applications (Outlook, Word, Excel, PowerPoint)
• Proven ability to drive end-to-end delivery of high-impact clinical priorities with clear accountability and measurable results
• Proven solid data analysis and interpretation skills with ability to focus on key performance indicators and metrics
• Proven excellent interpersonal communication skills including delivering executive presentations for both clinical and non-clinical audiences
• Proven success in change management and innovation
• Visibility and involvement in medical community
• Proven ability to thrive working in a matrix environment
• Proven organizational agility skills

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Compensation for this specialty generally ranges from $292,300 - $438,500. Total cash compensation includes base pay and bonus and is based on several factors including but not limited to local labor markets, education, work experience and may increase over time based on productivity and performance in the role. We comply with all minimum wage laws as applicable. 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.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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.