C&S Plan of Kentucky - Chief Medical Officer

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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. The position has accountability for all health plan product clinical product offerings, clinical market strategies, collaboration and oversight of our Shared Services clinical team, clinical data analysis to improve clinical and cost outcomes, new clinical program implementations, monitoring and valuing clinical outcomes and operational performance, driving affordability pipeline and performance, overseeing development and implementation of initiatives to meet quality standards, ensuring compliance with state Medicaid compliance standards-where applicable, and value based initiatives through clinical and vendor organizations. The Kentucky CMO is also responsible for the clinical relationships with our state client and key clinical leaders across the Commonwealth of Kentucky.

Major Responsibilities

1. Clinical Quality and Operational Performance- Oversight of clinical processes and policy decisions with a focus on implementing plans of care that meet accepted guidelines and protocols to ensure that optimal and appropriate medical/ clinical are provided in a cost-effective manner.

2. Strategic Clinical Leadership and Innovation- Development, implementation, and oversight of the population health strategy

3. Serves as chairman of the Health Plan's Quality Improvement Committee (QIC)

4. Financial oversight- Drive improved affordability related to medical and pharmacy spend for lower TCOC, greater capture of state level quality-based incentive dollars, and improved provider diagnosis, documentation and capture of member chronic conditions

5. Ensure services are delivered to members at the highest quality standards. Oversee and ensure development and implementation of initiatives to meet or exceed HEDIS quality standards, and accreditation standards through working with and holding Quality Shared Services accountable.

6. Develop strong collaborative partnerships across a highly complex and matrixed organization including key partnerships with the local Market leadership team, functional VPs, Market CMOs, health plan CEOs and Executive Directors across all lines of business (Commercial, Medicare, Medicaid)

7. Continuously improve HEDIS, and CAHPS scores for members and providers

8. Provide guidance and direction to physicians and nurses regarding all aspects of medical care and multi- level transitions of care including the referral process as well as any quality-of-care concern and related plans of correction

9. Review inpatient cases where applicable for successful bed-day management that meets established company goals

10. Analyze utilization data to identify trends and opportunities for process improvement related to medical treatment (inpatient and outpatient)

11. Serve as clinical subject matter expert for needs assessment, design, implementation, and evaluation of clinical programs to support continued growth and affordability of the Health Plan

12. State and Community Advocacy- Cultivate and sustain strong relationships across stakeholders to influence program design, develop support for program efforts, secure approvals and foster collaborative partnerships.

13. Participate in senior medical management strategy development and implementation to ensure that appropriate care and services provided to members meet best practice standards as well as regulatory compliance requirements and Internal Quality Assurance Program

14. Educate physicians and nurses in effective management of Health Plan benefits and medical services that meet the needs of the members and utilizes resources appropriately

15. Oversee the development and revision of the Health Plan's clinical care standards and practice guidelines and protocols

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 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 large health-system/clinically integrated network population health leadership
• Broad and comprehensive knowledge of medical management principles and insurance products for multiple and varied lines of business in a managed care environment
• Solid knowledge of Population Health and its 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

Core Competencies for the Indiana C&S CMO Role

• Solid clinical foundation in primary care (preferably) or subspecialty care (Board Certification an absolute requirement)
• Keen insight into the health care delivery system and how the various segments relate (MCOs, Hospitals, Physicians and Ancillary Services)
• Solid understanding of Long-Term Support Service Programs
• Understanding and demonstration of experience in 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, persuasive abilities and abilities to present with presence
• Ability to work well in a matrix structured organization where influencing others to participate in the health plans goals/agenda is imperative
• Thought leadership at the Kentucky Regulator level - very important to establish a solid relationship with the state CMO and exert influence on the cabinet's clinical agenda
• Familiarity and facility with the concept of Population Health and evidence of the creation of at least one Population Health clinical program
• Superior data analytic abilities in terms of understanding clinical data and how different metrics relate to each other, particularly as related to medical cost trend management
• Very solid leadership skills and characteristics to include emotional intelligence and empathy

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

Compensation for this specialty generally ranges from $278,000 to $417,500. 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.

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.