Job Summary
Job Description
Looking for a chance to drive measurable and meaningful improvement in the use of evidence-based medicine, patient safety, practice variation and affordability? You can make a difference at UnitedHealth Group and our family of businesses in serving our Medicare, Medicaid and commercial members and plan sponsors. Be part of changing the way health care is delivered while working with a Fortune 5 industry leader.
The medical director/CMO is actively involved in all major clinical functions, health programs and quality management components of UnitedHealthcare’s operations, including the Medically Frail portion of Kentucky HEALTH. The medical director/CMO oversees clinical operations initiatives that focus on clinical excellence, affordability and performance improvement. She/he oversees the development, implementation and review of quality improvement and quality of care (i.e., Internal Quality Assurance Plan), including implementation of and adherence to corrective action plans (CAPs). She/he is responsible for treatment policies, protocols, quality improvement activities, population health management activities and utilization management (UM) decision oversight, and for ensuring timely medical decisions. She/he is responsible for developing and implementing UM, disease management and quality management strategies to serve our enrollees. The medical director also oversees clinical directors, including those employed by subcontractors. The Medical director is responsible for driving clinical outcomes, whole person care and population health program performance and achieving medical loss ratio objectives for the health plan while ensuing members receive the right care in the right service setting. The scope of the role will include 7 direct and 2 indirect reports spanning the scope of quality, clinical, dental, opioid use disorder/substance use disorder, program, pharmacy and psychiatry/behavioral health.
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.
- A Board-certified medical physician with an active license in Kentucky
- Experience with Medicaid and Dual Eligible members
- 3 + years of training in a medical specialty and 5 years of experience post-training providing clinical services
- Previous successful experience leading disease management/quality improvement/care management program activities at a health system, large safety-net provider, or managed care plan with demonstrated outcomes and available for after-hours consultation
- Must reside in, or be willing to relocate to, the Commonwealth of Kentucky
- Background in internal medicine, pediatrics, obstetrics/gynecology, family medicine, or geriatrics
- Experience with integration of care for dual-eligible enrollees
- Experience managing a matrix environment
- Experience in a managed care organization
- Experience managing staff
- Previous work with care coordinators, including review of care plans
- Experience with substance use disorder/opioid use disorder treatment programs or public health initiatives